Living donors represent a recognized alternative for facilitating the access to transplantation in a period of organ shortage.
However, which candidates should be preferentially considered for living-donor liver transplantation is debated.
Dr François Durand and colleagues from France determined which strategies of selection for living-donor liver transplantation provide the most efficient contribution.
The investigative team created statistical models assess the strategies.
The team included 331 patients listed for deceased-donor transplantation and 128 transplanted with living donors.
|3-year survival was 70% in those at highest risk of death vs 64% with the lowest risk|
Statistical models predicting the events following listing were created and combined in a multistate model to compare the results.
This allowed the testing of different strategies of selection for living-donor liver transplantation.
The investigators took 3-year survival after listing as the principal end-point.
The team found that selecting the 20% patients at highest risk of death on the waiting list gave 3-year survival results in 70%.
Selecting the 20% patients at lowest risk of death after living-donor liver transplantation lead to 3-year survival rates in 64%.
These strategies resulted in waiting list mortality rates of 17% and 8%, respectively.
The team noted that 1-year survival after living-donor liver transplantation was lower in high-risk patients at 85% than in low-risk patients at 91%.
However, the 1-year survival benefit derived from living-donor liver transplantation was 75% in high-risk patients.
The investigators observed that the 1-year survival was nil in low-risk patients.
Dr Durand's team concludes, “Living-donor liver transplantation is more effective for overcoming the consequences of organ shortage when performed in patients at high risk of death on the waiting list.”
“On an individual basis, the sickest patients are those who derive the most important benefit from living-donor liver transplantation.”
“This study provides incentives for considering living-donor liver transplantation in high-risk patients.”