PITTSBURGH, July 12, 2019 - Living-donor liver transplant offers numerous advantages over deceased-donor transplant, including better three-year survival rates for patients and lower costs, according to new research from the UPMC Thomas E. Starzl Transplantation Institute and the University of Pittsburgh School of Medicine.
The findings, published online today in the Annals of Surgery, highlight living donation as a viable, if not preferable, option for the more than 14,000 people currently on the waiting list, as well as many more who never qualify to be on the list under current allocation rules.
About 8,000 liver transplants are performed each year, according to the Organ Procurement & Transplantation Network, and living-donor liver transplant comprises less than 5% of that total. Additionally, about 25% of people on the waiting list die each year waiting for a transplant, and those who eventually receive a transplant often have a lengthy period on the waiting list, resulting in poorer health at the time of transplant.
"The consequences for patients on the waiting list can mean the difference between life and death because the longer they are waiting, the sicker they become," said Abhinav Humar, M.D., chief of transplant services at UPMC, clinical director of the Thomas E. Starzl Transplantation Institute and lead author of the study. "Living-donor liver transplants, in tandem with deceased-donor liver transplants, represents an opportunity to significantly decrease the risk of wait-list mortality, and gives us the ability to transplant a person sooner."
The retrospective review of 245 adult living-donor liver transplants and 592 deceased-donor liver transplants performed over the last 10 years at UPMC--which has the country's largest living-donor liver transplant program--compared survival rates and other outcomes such as recovery times, complications, costs and resource utilization. The patients were followed for at least two years post-transplant.
Of those comparisons, three-year patient survival outcomes were superior in living-donor liver transplant recipients--86% versus 80%. Living-donor liver transplant recipients overall had about a 5% survival advantage over deceased-donor recipients. Patients who received a liver from a living donor had a hospital stay of 11 days as compared to 13 days for those who received a liver from a deceased donor, had less likelihood of intraoperative blood transfusion (53% compared to 78%) and less likelihood of the need for post-transplant dialysis (1.6% versus 7.4%). Hospital costs related to transplant also were 29.5% lower for living donor recipients. For the living-liver donor, there were no mortalities observed, and the overall complication rate was 20%.
"Living-donor liver transplant should be considered the first and best option for most patients with liver disease," Humar said. "It is not only an option for those on the waiting list but could perhaps offset the fact that not everyone who may benefit from transplant qualifies to receive a deceased-donor transplant based on today's current rules of allocation."
Given the advantages, UPMC in recent years expanded its living-donor liver transplant program. In 2018, living-donor transplants comprised about 54% of the program's total number of liver transplants compared to the national average of around 4%. UPMC's transplant rate also increased from 45 out of every 100 persons on the program's waiting list in 2015 to around 88 in 2018. The program has led the country in living-donor liver transplants the past two years and is the only center in the U.S. to perform more living- than deceased-donor transplants.
"It is unclear why the number of living-donor liver transplants is so low in the United States," said Amit Tevar, M.D., associate professor of surgery in the Pitt Department of Surgery and director of the Kidney and Pancreas Transplant Program at UPMC. "Fewer than 15 U.S. programs did more than 10 living-donor liver transplants in 2018, and this is surprising given the number of analyses nationwide like this that have now been reported."
Additional authors on the study include Swaytha Ganesh, M.D., Dana Jorgensen, Ph.D., M.P.H., Armando Ganoza, M.D., Michele Molinari, M.D., and Christopher Hughes, M.D., all of Pitt.
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A $20 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates 87,000 employees, 40 hospitals, 700 doctors' offices and outpatient sites, and a 3.5 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.2 billion in benefits to its communities, including more care to the region's most vulnerable citizens than any other health care institution, and paid $587 million in federal, state and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America's Best Hospitals. For more information, go to UPMC.com.
About the University of Pittsburgh School of Medicine
As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.
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Annals of Surgery