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Meta-Analysis
. 2021 Jul;21(7):2399-2412.
doi: 10.1111/ajt.16440. Epub 2021 Jan 5.

Meta-analysis and meta-regression of outcomes for adult living donor liver transplantation versus deceased donor liver transplantation

Arianna Barbetta  1   2 , Mayada Aljehani  3 , Michelle Kim  1   2 , Christine Tien  2 , Aaron Ahearn  1   2 , Hannah Schilperoort  4 , Linda Sher  1   2 , Juliet Emamaullee  1   2
Affiliations
Meta-Analysis

Meta-analysis and meta-regression of outcomes for adult living donor liver transplantation versus deceased donor liver transplantation

Arianna Barbetta et al. Am J Transplant. 2021 Jul.

Abstract

Prior single center or registry studies have shown that living donor liver transplantation (LDLT) decreases waitlist mortality and offers superior patient survival over deceased donor liver transplantation (DDLT). The aim of this study was to compare outcomes for adult LDLT and DDLT via systematic review. A meta-analysis was conducted to examine patient survival and graft survival, MELD, waiting time, technical complications, and postoperative infections. Out of 8600 abstracts, 19 international studies comparing adult LDLT and DDLT published between 1/2005 and 12/2017 were included. U.S. outcomes were analyzed using registry data. Overall, 4571 LDLT and 66,826 DDLT patients were examined. LDLT was associated with lower mortality at 1, 3, and 5 years posttransplant (5-year HR 0.87 [95% CI 0.81-0.93], p < .0001), similar graft survival, lower MELD at transplant (p < .04), shorter waiting time (p < .0001), and lower risk of rejection (p = .02), with a higher risk of biliary complications (OR 2.14, p < .0001). No differences were observed in rates of hepatic artery thrombosis. In meta-regression analysis, MELD difference was significantly associated with posttransplant survival (R2 0.56, p = .02). In conclusion, LDLT is associated with improved patient survival, less waiting time, and lower MELD at LT, despite posing a higher risk of biliary complications that did not affect survival posttransplant.

Keywords: clinical research / practice; liver transplantation / hepatology; liver transplantation: living donor; meta-analysis.

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Conflict of interest statement

Disclosure: The authors have of this manuscript have no conflict of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1:
Figure 1:
PRISMA diagram of Systematic Review.
Figure 2:
Figure 2:. Forest plot of Hazard Ratios for overall patient survival at 1 year (a), 3 years (b), and 5 years (c) post-transplant.
LDLT favored patient survival when compared to DDLT at all time points.
Figure 3:
Figure 3:. Forest plot of hazard ratios for overall graft survival at 1 year (a), 3 years (b), and 5 years (c) post-transplant.
LDLT and DDLT had equivalent graft survival at 1-, 3- and 5-years post-transplant.
Figure 4:
Figure 4:. Forest plot of pre-operative variables.
Panel A: MELD at transplant and Panel B: Time on Waiting List. LDLT favored lower MELD at transplant and less time on the waiting list.
Figure 5:
Figure 5:. Forest plot of post-operative variables.
Panel A: Hepatic Artery Thrombosis, Panel B: Biliary Complications, Panel C: Risk of Infection, Panel D: Length of Stay, Panel E: Rejection rate. LDLT was equivalent to DDLT for rates of post-operative HAT (A), infections, and length of stay (D). LDLT were more likely to have biliary complications (B) and had a lower risk of rejection when compared to DDLT (E).
Figure 6.
Figure 6.. Random effects meta-regression
showing how results of meta-analysis examining 1-year patient survival are influenced by the difference in MELD score between LDLT and DDLT. Each dot represents an individual study, the solid line represents the regression prediction, and the dotted lines the 95% Confidence intervals.
See this image and copyright information in PMC

References

    1. Goldberg DS, French B, Abt PL, Olthoff K, Shaked A. Superior survival using living donors and donor-recipient matching using a novel living donor risk index. Hepatology. 2014;60(5 PG-1717–1726):1717–1726. doi:10.1002/hep.27307 - DOI - PMC - PubMed
    1. Olthoff KM, Smith AR, Abecassis M, et al. Defining long-term outcomes with living donor liver transplantation in North America. Ann Surg. 2015;262(3 PG-465–475; discussion 473–465):465–475; discussion 473. doi:10.1097/sla.0000000000001383 - DOI - PMC - PubMed
    1. Abt PL, Mange KC, Olthoff KM, Markmann JF, Reddy KR, Shaked A. Allograft survival following adult-to-adult living donor liver transplantation. Am J Transpl. 2004;4(8 PG-1302–1307):1302–1307. doi:10.1111/j.1600-6143.2004.00522.x - DOI - PubMed
    1. World Health Organization. GENERAL INFORMATION OF THE COUNTRY. Global Observatory on Donation and Transplantation. http://www.transplant-observatory.org/. Published 2020. Accessed March 3, 2020.
    1. Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2017 Annual Data Report: Liver. Am J Transplant. 2019;19:184–283. doi:10.1111/ajt.15276 - DOI - PubMed

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