Authors' objectives:

The objective of this review was to assess the safety of live donor liver transplants (LDLT) for the donor and to determine if LDLT has comparable safety and efficacy outcomes to cadaveric liver transplantation (CLT) for adult recipients.

Authors' results and conclusions: Three hundred and seven (307) studies provided information on donor outcomes and 246 studies provided information on recipient outcomes. Most of the studies were case series, but some compared live donor liver transplantation with cadaver liver transplantation and there were also comparisons between different types of grafts, for example. There is likely to have been both under-reporting and duplicate reporting, so the following results should be interpreted cautiously. Donor outcomes: Overall reported donor mortality was 13 in about 6,000 procedures (0.2%) (117 studies). Mortality for right lobe donors to adult recipients is estimated to be 4-10 out of 2,000 (0.2 to 0.5%), and 2-6 out of 3,300 (0.06 to 0.18%) for left lobe donors to child recipients. The donor morbidity rate ranged from 0% to 100% with a median of 16%; 131 studies. Biliary complications and infections were the most commonly reported donor morbidities. Nearly all donors had returned to normal function by three to six months (18 studies). On average, one in three potential donors eventually donated part of their liver. Recipient outcomes: Adult recipient mortality ranged from 0% to 50%, with a median of 12.5%; 115 studies. Death was most commonly due to various forms of infection, hepatic and multiple organ failure, and recurrent disease. Total complication rates ranged from 0% to 100% with a median of 45%; 20 studies. The most common complications were biliary or hepatic complications or infections. Generally the complication rate and other outcomes were similar to those seen for adult cadaver liver transplantation, except for biliary complications, which may have been more frequent in LDLT.

Authors' recommendations: Recipient outcomes are similar for adult-adult live donor (AA LDLT) and cadaver liver transplantation (CLT). There are small, but real, risks for live liver donors. Although live donor liver transplantation has the potential to help address the demand for livers, its current impact on waiting lists is relatively small. On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications and recommendations concerning the donor and recipient safety and recipient efficacy of live donor liver transplantation: Classifications: Evidence rating - The available evidence was assessed as poor; however it is recognised that most of the evidence regarding the safety and efficacy of LDLT has to be derived from case series and registries. Even so, there are particular concerns about under-reporting of mortality and morbidity for both donors and recipients, which also contributes to the classification of poor. Safety - Donors: There is some risk of mortality and morbidity for LDLT donors, and the long term risks are unknown. (Since there is no comparator (except not donating), safety can only be described in absolute terms.) Efficacy - Donors: Not applicable, although clearly donors incur costs in terms of lost time and need for additional resources (financial and other). Safety - Recipients: Cannot be determined. Efficacy - Recipients: Cannot be determined. The panel recommended that strict guidelines are necessary for the performance of AA LDLT, in particular with respect to the process of LDLT donor selection, and contraindications for donor selection, and to the process of listing potential LDLT recipients. The Transplantation Society of Australia and New Zealand has developed guidelines for the performance of AA LDLT, which can be accessed online at http://www.racp.edu.au/tsanz. Additionally, the panel acknowledged the poor evidence available for LDLT, and suggested that all LDLT procedures need to be submitted to a registry, and that any centres not prepared to submit data should not be authorised to be transplant centres.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/publications_livedonorlivertransp.htm

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical