Abstracts
2002 Digestive Disease Week

# 101634 Abstract ID: 101634 A Case-Control Study to Evaluate the Safety and Efficacy of Living Donor Liver Transplantation
A Osama Gaber, Ahmed Aljedai, Marsha Honaker, Agnes Lo, Han Grewal, Mark Levstik, Jonathan Fisher, Santiago Vera, Nosratollah Nezakatgoo, M Hosein Shokouh-Amiri, Memphis, TN

Introduction: Living donor liver transplant (LDLT) is a technically demanding procedure with potential risks to both donors and recipients. To date, there are no prospective, controlled clinical trials to evaluate the safety and efficacy of LDLT. To circumvent this and to attempt to provide controlled data on the procedure, we compared the outcomes of our LDLT recipients with cadaveric liver transplant recipients (CAD-R) in a case-controlled study. Methods: From 01/1999 to 10/2001, our center has preformed 21 adult LDLT. 23 controlled adult cadaveric liver transplant recipients (CAD-R) were matched for age, gender, and ethnicity, time of transplant, UNOS status, Childs-Pugh scores, caval preservation, surgical techniques, and immunosuppression by a clinician blinded to the outcomes. Results:The median age of the donors was 36 years with 48% of male and 5% African-Americans. The donors consisted of children (52%), siblings (28%), wives (14%), and friends (5%). One donor had a biliary leak requiring percutaneous drainage, but no other donor complications had occurred. Because of the case-controlled design, there were no differences in demographics and transplant characteristics between the LDLT-R and the CAD-R. The median time from listing to transplant was higher in the CAD-R than in the LDLT-R (174 days Vs 56 days, p=0.09). At 1 year, the patient and graft survival rates for the LDLT-R were 81% and 76%, respectively, compared to 96% and 87% in CAD-R (p=0.13, p=0.34). There were no differences in the incidence of acute rejection and recurrence of hepatitis C between the two groups. Liver functions as assessed by albumin, AST, ALT, bilirubin, and PT during the first 14 days post-transplant and at 1, 6, and 12 months post-transplant were similar in both groups. The initial length of stay for the LDLT-R was 16 days compared to 11 days for the CAD-R, p=0.09. The incidence of bile leak was higher in LDLT-R than in the CAD-R, 33% vs 17%, p=NS. The incidences of portal vein thrombosis and hepatic artery thrombosis were low in both groups, 6% and 9%, respectively. The incidence of readmissions, re-operative rates, and infections did not differ between the two groups. Conclusion: Living liver donation was safe. The clinical outcomes of the recipients were comparable, but LDLT has the potential to reduce waiting time and increase the donor pool for liver transplantation. Managing the learning curve of the procedure could improve its potential for wide spread applications.