Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings from the A2ALL Cohort Study

Adult-to-adult living donor liver transplantation is performed with increasing frequency at major transplantation centers, but too few cases are performed at any one center to discern reliable information about the risks and complications of this procedure.

To address this knowledge gap, Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) researchers analyzed data on over 1,000 liver transplant recipients — from both living and deceased donors — from 1998 to 2010.

The authors of the study used statistical models to compare probabilities of complications and their resolution. Recipients of deceased donor transplants were more likely to have hepatocellular carcinoma (HCC) and higher disease severity, including higher Model for End-stage Liver Disease (MELD) scores. Deceased donor recipients also had a higher probability of ascites, intra-abdominal bleeding, cardiac complications, and pulmonary edema. 

On the other hand, recipients of living donor transplants were more likely to experience biliary-related complications and hepatic artery thrombosis (HAT), but were less likely to develop chronic kidney disease.

In contrast to the differences in the occurrence of post-transplant complications, the time to resolve complications did not differ between recipients of living donor transplants and deceased donor transplants.

Robert Merion, MD, FACS, who co-authored the study, noted, “We were surprised that the time to resolution of complications was so similar in the living donor and deceased donor liver transplant recipients in the A2ALL study. This clearly points to the need to prevent complications in the first place, rather than the ‘failure to rescue’ issues that have been identified in other general surgical procedures.” The authors conclude that future efforts should be directed towards reducing complications after liver transplantation. 

CITATION:Samstein B, Smith AR, Freise CE, Zimmerman MA, Baker T, Olthoff KM, Fisher RA, Merion RM. Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study. Am J Transplant 2016 Feb;16(2):594-602 doi: 10.1111/ajt.13479.
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