Living Donor Transplant Safe, Effective

Healthy Living Donors Can Bypass Liver Shortage for Transplantation

From the WebMD Archives

Oct. 14, 2003 (Baltimore) -- If you need a liver transplant, don't be afraid to ask your children or siblings to share theirs, say doctors who found that living donor liver transplants are extremely safe for both donor and recipient.

People who receive a new liver from a living donor are less likely to suffer serious complications or reject their new organ than people who undergo a traditional transplant procedure, which uses livers from cadavers, says Parvez S. Mantry, MD, assistant professor of medicine in the Digestive Disease Unit at the University of Rochester in Rochester, N.Y. And there's a hint they are more likely to survive as well, he says.

The research was presented Monday at the 68th Scientific Meeting of the American College of Gastroenterology.

Critical Shortage of Livers

The liver is one of the largest organs in the body and has numerous functions, such as producing bile and blood proteins, storing vitamins for later use, and removing toxins (including alcohol) from the blood.

There has long been a critical shortage of cadaver livers for transplantation, Mantry says. In his area of the country alone, there are 3,000 people with failing livers on the waiting list but only 300 livers to go around. Nationally, more than 15,000 individuals are waiting, with only 4,000 organs in the donor pool.

The shortage led to the development of living donor liver transplantation, which was first performed in the U.S. in 1989, he says. But it's been slow to catch on at some hospitals, with critics arguing that taking liver tissue from living donors is unethical. "They say any risk is unacceptable to healthy people," Mantry tells WebMD.

In the procedure, a healthy donor, usually a blood relative, undergoes an operation that takes several hours. The liver from the donor is split into two segments, and one portion is removed and transplanted into the recipient after removal of the diseased liver. After the lengthy surgery, the donor has to remain in the hospital for a week or longer. The removed section of the liver from the donor will eventually regenerate itself.

Mantry says his team has previously presented research showing that living organ transplantation is extremely safe for the donor. In that study, no donors died in the year following the procedure. One in 10 donors suffered complications but most were easily treatable.

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"Better Than Expected" Results

The new study, which Mantry says represents the largest single-center experience with living donor liver transplantation in the U.S., looked at how the recipients fared.

"As a whole, they did very well, better than would be expected with [conventional cadaveric] transplantation," he says.

Of the 92 patients who underwent living donor liver transplantation at the University of Rochester in 2001-2002, more than 90% survived past six months, and more than 85% of the transplant recipients did not suffer severe complications from the transplant.

Nearly half of the patients received the liver from their children, nearly one-third from siblings, and 2% from a second-degree relative, he says. The rest were donated from spouses and friends, which, because they do not share the same genetics, have a greater change of being rejected by the body.

But the study showed that overall, there were fewer cases in which the patient rejected the donated organ than would be expected with the conventional procedure. "All were successfully treated with no major adverse outcomes," he says.

Karen Woods, MD, clinical associate professor of Medicine at Baylor College of Medicine in Houston, predicts we'll be seeing more and more of these procedures.

"If the procedure proves to be as successful as this study suggests, with a lower complication rate than [conventional] transplantation, this could be an enormous advantage for patients on the waiting list," says Woods.

Woods tells WebMD that as a practicing gastroenterologist, she has patients who continue to suffer for several years while awaiting a donor. "They're anxious, their families are anxious, they want to get on with their lives. The opportunity to have a living donor would be welcome if it is indeed as safe as this study suggests."

Despite their optimism, both Woods and Mantry caution that the jury won't be completely in until more patients are watched for even longer periods of time.

WebMD Health News

Sources

SOURCES: 68th Annual Scientific Meeting of the American College of Gastrenterology, Baltimore, Oct. 12-15, 2003. Parvez S. Mantry, MD, assistant professor of medicine, University of Rochester, Rochester, N.Y. Karen Woods, MD, clinical associate professor of medicine, Baylor College of Medicine, Houston. The Center for Liver Disease and Transplantation, Columbia University.
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