Thuluvath PJ and Yoo HY (2004) Graft and patient survival after adult live donor liver transplantation compared to a matched cohort who received a deceased donor transplantation. Liver Transpl 10: 1263–1268

In response to an acute cadaver organ shortage, live donor liver transplantation (LDLT) is becoming more common. The procedure is associated with significant donor morbidity and a degree of donor mortality. It is important, therefore, to balance the risk to the donor against the likelihood of a positive outcome in the recipient. To this end, Thuluvath and Yoo have assessed the outcomes in patients who underwent LDLT, compared with those subjected to deceased donor liver transplantation (DDLT).

Using data from the United Network for Organ Sharing database, the authors identified all adults who underwent LDLT in the US between 1988 and 2001. Most of the 764 procedures had been performed since 1998. Case-controls (n = 1,470), who underwent DDLT during the same period, allowed comparison of rates of graft and patient survival.

Primary graft nonfunction and acute rejection occurred at similar rates in patients who underwent LDLT or DDLT. Patient survival at 2 years was also similar in the two groups (79.0% in LDLT vs 80.7% in DDLT; P = 0.5). Two-year graft survival, however, was significantly lower in the LDLT group compared with the DDLT group (64.4% vs 73.3%, P <0.001). This corresponded to a 60% higher risk of graft loss in the LDLT group, after adjusting for confounding variables.

Commenting that outcomes can be expected to improve as experience of LDLT is accumulated, Thuluvath and Yoo conclude that the procedure is a reasonable option in cases where DDLT is not available.