Date: Tuesday, May 5, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:03pm-3:15pm
Location: Room 115-AB
Purpose: To determine the benefit of living donor liver transplantation (LDLT) compared to deceased donor liver transplantation (DDLT) in the treatment of end stage liver disease secondary to biliary atresia (BA) in the PELD era.
Methods: Retrospective review of all pediatric liver transplants performed at a single institution for the treatment of BA between 3/04 to 11/14.
Results: During the study period 74 consecutive patients with BA received a transplant: 30 DDLT and 44 LDLT. DDLT recipients were significantly older than LDLT recipients (622 vs 586 days) and had a longer listing-to-transplant time (150 vs 68 days). DDLT recipients were slightly larger than LDLT recipients (10.9 vs 10.0 kg) and more cholestatic (bilirubin 13.9 vs. 11.0 mg/dL) with a slightly higher calculated PELD score (15 vs. 14.3). A left lateral segment graft was used in 83% of DDLT and 91% of LDLT; only one whole organ DDLT was performed. All but 2 deceased donor grafts were split in-situ. An end-to-end hepatic arterial anastomosis was fashioned in 98% of LDLT and 53% of DDLT with a direct aortic anastomosis created in the remainder. One hepatic artery thrombosis and one bile leak occurred in a LDLT. The incidence of portal vein thrombosis was similar between DDLT and LDLT (6.7% vs 9.1%). The incidence of biliary stricture was higher in DDLT compared to LDLT (10% vs 4.6%). The overall re-operation rate was higher in LDLT compared to DDLT (22.7% vs. 16.7%). The 1- and 5- year Kaplan-Meier DDLT graft survival was marginally but insignificantly higher than LDLT (100% vs. 93%) and (91% vs 85%), p=0.311. The 1- and 5- year Kaplan-Meier DDLT patient survival was not significantly different from that of LDLT (98% vs. 100%) and (89% vs. 91%), p=0.634. The single mortality within the first year in a LDLT was secondary to post-operative sepsis due to pre-operative cholangitis.
Conclusions: Contrary to previously published results, superior 1- and 5- year patient survival can be obtained with either DDLT or LDLT for the treatment of BA. However, recipients of LDLT had shorter time from listing-to-transplant despite an equivalent degree of illness. This is of particular importance in high acuity regions of the country were limited organ availability may result in increased waitlist mortality.
To cite this abstract in AMA style:Alexopoulos S, Nekrasov V, Matsuoka L, Chouliaras K, Genyk Y. Living Donor Liver Transplantation for Biliary Atresia has Equivalent Survival and Shorter Waiting Time Compared to Deceased Donor Liver Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/living-donor-liver-transplantation-for-biliary-atresia-has-equivalent-survival-and-shorter-waiting-time-compared-to-deceased-donor-liver-transplantation/. Accessed April 7, 2020.
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