Liver donor type may sway primary sclerosing cholangitis outcomes
Lower success rate, more need for second procedure in living donor transplant
Liver transplants from a living donor may mean a lower success and a higher need for a second transplant relative to those from a deceased donor in people with primary sclerosing cholangitis (PSC), a U.S. study suggests.
Still, outcomes with a living donor transplant generally improved over time and were associated with similar survival rates as transplants from deceased donors.
Taking the multiple types of liver transplant into consideration “may enable continued safe expansion of the available donor pool in recipients with PSC” to allow more patients to promptly receive the potentially life-saving procedure, the researchers wrote.
The study, “Impact of graft type on outcomes following liver transplantation for primary sclerosing cholangitis,” was published in Hepatology International.
PSC is a chronic autoimmune liver condition marked by cholangitis, or inflammation in the tubes that carry the digestive fluid bile from the liver to the small intestine. Chronic cholangitis can seriously harm the liver and there are no available treatments for slowing or stopping PSC-related liver damage. The only way to cure PSC is through a liver transplant, but the disease can recur even after the procedure.
The most common type of liver transplant is a donation after brain death (DBD), where the liver is taken from a deceased person who has been declared brain dead. Due to donor organs being scarce, other types of transplants may be used for PSC, however.
These include donation after circulatory death (DCD), where the donated liver comes from a deceased person after their heart stops beating, and a living donor transplant, where a healthy living person donates a portion of their liver that’s capable of regenerating into a fully working organ.
Some studies suggest the type of liver donor can affect outcomes in PSC, with less favorable outcomes after DCD or living donor transplants, but the findings have differed.
Comparing outcomes with liver transplant donor type
Here, scientists looked at registry data from 2,966 adults with PSC who received a liver transplant in the U.S. between 2010 and 2020 to further explore what impact the type of liver transplant donor has on PSC patient outcomes.
Most patients (90.4%) received a DBD transplant. The rest underwent a DCD (4.4%) or living donor transplant (5.2%), both of which increased over time.
Graft loss, where the transplanted liver stops working properly, happened with 24.2% of patients with a living donor transplant, 18.3% in the DBD group, and 15.3% of those who had a DCD transplant.
Significantly more patients in the living donor transplant group underwent a second transplant (15%) during the study period than in the DCD (11%) and DBD (7%) groups.
Graft survival, or the length of time a transplanted liver functions properly, was comparable in the DCD and DBD groups, but tended to be shorter among those who received a living donation, although the difference wasn’t statistically significant.
Why graft survival is lower with living donor transplants is “not entirely clear,” the scientists wrote, but is consistent with previous studies and “warrant further study with longer duration of follow-up.”
Patient survival is similar
Overall patient survival was similar between the three groups. Patient survival and transplant success rates improved over time among those who received a living donor transplant, and patient survival in the DCD group also improved significantly over the study period.
These improved outcomes are likely related to increased clinical experience, including better surgical techniques and donor selection, the researchers said.
A living donor transplant was the strongest risk factor of worse graft survival, being associated with an 65% higher risk, further statistical analyses showed. A longer cold ischemia time, or a longer period when the liver was preserved without blood flow before being transplanted, was the strongest risk factor of poorer patient survival, being linked to a 30% increased risk. A DCD transplant “was not associated with either graft or patient survival,” the researchers wrote.
Also, PSC patients who received a living donor or DCD transplant exhibited better survival than a group of people who received such transplants for reasons unrelated to PSC.
The scientists said their inability to ascertain the proportion of patients who developed recurrent PSC after transplant or the reasons for graft loss or death in individual patients were study limitations. They said larger studies are needed “to draw meaningful conclusions regarding outcomes,” given the relatively low numbers of patients who underwent DCD or living donor transplants during the study.
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