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OUTCOME OF LIVING DONOR LIVER TRANSPLANTATION (LDLT) : GRAFT SURVIVAL IS POOR
ESPECIALLY IN HCV RECIPIENTS
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P.J. Thuluvath, H.Y. Yoo,
Department Of Medicine, The Johns Hopkins University School Of Medicine,
Baltimore, MD, USA
Anecdotal experience also shows that LDLT recipients with HCV may have a poor
outcome. Objective: To analyze the outcomes of LDLT and compare the results
to a matched population who received cadaver liver transplant (CLT) using
UNOS data. Patients & Methods: For each LDLT recipients (n=764), two CLT
recipients (case-controls, n=1470), matched for age, sex and diagnosis, were
selected from the UNOS data. Results: As per study design, both groups had
similar age, sex and etiology. 2.5% (n=19) of the recipients had previous
liver transplantation, and there was no multi-organ transplantation along
with LDLT. Recipients of LDLT had more stable liver disease as shown by fewer
patients with UNOS status 1, in ICU or with life support. Creatinine and cold
ischemia time were higher in the CLT groups. Incidence of primary graft
non-function and 2-year Kaplan-Meier survival was similar in both groups
(79.0% in LDLT vs. 80.7% in case-controls, p=0.56). 2-yr graft survival was
lower in LDLT (64.4% vs. 73.3%, p <0.001). Cox regression (after adjusting
for confounding variables) showed a significantly lower graft (HR 1.6)
survival in LDLT. HCV positive LDLT recipients showed lowest graft survival
when compared to non-HCV LDLT recipients or HCV patients who received CLT.
Conclusion: LDLT recipients are less sick than CLT recipients. Although
2-year patient survival in LDLT is similar to a matched population who
received CLT, 2-year graft survival was significantly lower in LDLT
recipients. HCV recipients who had LDLT had a poor survival compared to
either CLT recipients with HCV or non-HCV LDLT recipients.
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