Living vs. deceased donor liver transplantation provides comparable recovery of renal function in patients with hepatorenal syndrome: A matched case-control study

Abstract

Outcomes of living versus deceased donor liver transplantation in patients with chronic liver disease and hepatorenal syndrome (HRS) was compared using a matched pair study design. Thirty patients with HRS receiving a live donor liver transplantation (LDLT) and 90 HRS patients receiving a full graft deceased donor liver transplantation (DDLT) were compared. LDLT versus DDLT of patients with HRS was associated with decreased peak aspartate aminotransferase levels (339-±-214 vs. 935-±-1253-U/L; p-=-0.0001), and similar 7-day bilirubin (8.42-±-7.89 vs. 6.95-±-7.13-mg/dL; p-=-0.35), and international normalized ratio levels (1.93-±-0.62 vs. 1.78-±-0.78; p-=-0.314). LDLT vs. DDLT had a decreased intensive care unit (2 [1-39] vs. 4 [0-93] days; p-=-0.004), and hospital stay (17 [4-313] vs. 26 [0-126] days; p-=-0.016) and a similar incidence of overall postoperative complications (20% vs. 27%; p-=-0.62). No difference was detected between LDLT and DDLT patients regarding graft survival at 1 (80% vs. 82%), at 3 (69% vs. 76%) and 5 years (65% vs. 76%) (p-=-0.63), as well as patient survival at 1 (83% vs. 82%), 3 (72% vs. 77%) and 5 years (72% vs. 77%) (p-=-0.93). The incidence of chronic kidney disease post-LT (10% vs. 6%; p-=-0.4) was similar between both groups. LDLT results in identical long-term outcome when compared with DDLT in patients with HRS. Using a matched case-control study, the authors find that live donor liver transplantation when compared to deceased donation provides similar outcome in patients suffering from hepatorenal syndrome, and they discuss live donation as a strategy to provide immediate access to transplantation for this patient population.