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Does A Living Donor Liver Transplant (LDLT) Program Reduce Wait-List Mortality?
James J Pomposelli, *Mary Ann Simpson, *Mohamed E Akoad, Roger L Jenkins, William D Lewis, Elizabeth A Pomfret
Lahey Clinic Medical Center, Burlington, MA

Objective:
Current wait-list mortality for patients with end-stage liver disease is 23% in New England. The objective of this study was to determine if the availability of LDLT reduces patient wait-list time, morbidity and mortality.
Design:
Cohort comparison of 204 recipients who underwent LDLT to 198 candidates who died on the wait-list during the same time period.
Setting:
Tertiary care referral center.
Patients:
Between 2002-2013, 402 patients with end-stage liver disease who were on the liver transplant wait-list either received a LDLT (n=204) or died while waiting (n=198) were compared. The remainder of patients on the list continue to wait for a deceased donor or are trying to find suitable living donor.
Interventions:
Expedited liver transplant using a living donor versus continued waiting.
Main Outcome Measures:
Candidate demographics, diagnosis, time to referral, time on the list, complications while waiting, disease severity at the time of listing and at either death or transplant as suggested by the model for end-stage liver disease (MELD) score, platelet count, and serum albumin.
Results:
Table 1
Died on Wait-list N=198LDLT Transplant N=204Significance
Diagnosis to Referral (Days)2112 (8-7395)1013 (4-3912)0.001
Diagnosis to Listing2592 (7-9667)1718 (8-4426)0.001
Referral to Listing525 (7-4353)295 (8-726)0.001
Days Inactive2324 (0-6003)58 (0-784)<0.001
MELD \@ Evaluation15.7 +/- 6.514.1 +/- 5.2NS
MELD \@ Death or Transplant24.4 +/- 12.914.8 +/- 5.20.001
Gender62% Male72% Male0.05
Age \@ Death or Transplant57.8 +/- 7.650.6 +/- 12.20.003
Spontaneous Bacterial Peritonitis (SBP)43.3 %26.9%0.001
Serum Albumin \@ Evaluation2.6 (1.2-4.1)3.2 (2.0-4.4)0.01
Serum Albumin \@ Death or Transplant2.5 (0.9-5.8)3.0 (2.1-4.1)0.01
Platelet Count \@ Evaluation105.6 (23-547)149 (41-302)0.009
Platelet Count \@ Death or Transplant70.1 (10-414)136 (42-302)0.002
Hepatitis C (HCV) and alcohol were the 2 most common causes of cirrhosis. Patients who underwent LDLT had 90% 1 year and 85% 3 and 5 year survival.
/>Conclusions:<br The availability of a living donor liver transplant program significantly reduces candidate wait-list time, morbidity and mortality while allowing them to be transplanted in an improved clinical condition. Given the potential for donor complications or death, donors and recipients should be evaluated and selected carefully to ensure favorable long-term outcome.


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