Fourteen studies (n=712) evaluated donor outcomes: 1 non-randomised comparative study and 13 case series. Eleven studies evaluated recipient outcomes: 9 non-randomised comparative studies with historical and/or concurrent controls and 2 retrospective analyses of registry data.
Donor outcomes (14 studies).
The mean length of LDLT donor operation ranged from just under 4 to 6 hours, with an average hospital stay of 5 to 14 days. Few donors needed a blood transfusion, and the most common complications were bile leakage (0 to 10%), incisional hernia (2 to 6%), gastroduodenal ulcers (1 to 6%) and wound infection (2 to 6%). The mortality rate for live donors was 0.15%, while approximately 4% of donors required another operation because of LDLT-related complications.
Recipient outcomes.
Cadaveric whole liver transplantation versus LDLT (8 studies).
Cadaveric whole liver transplantation and LDLT were found to have similar overall rates of graft and patient survival: median 5-year survival for patients was 92% with LDTL versus 81% with cadaveric; median 5-year survival for grafts was 81% with LDLT versus 73% for cadaveric transplantation. No clear benefit was found between graft types in terms of vascular complications, bile leakage, reoperation, or graft dysfunction.
An analysis of registry data suggested that LDLT was associated with lower mortality and graft failure rates than cadaveric graft in children younger than 2 years, whereas cadaveric whole graft transplantation was associated with lower rates of mortality and graft failure in children aged 2 to 16 years. LDLT was more likely to be done as an elective procedure in patients with a stable medical state undergoing their first transplant. RSLT versus LDLT (5 studies).
LDLT was associated with more favourable graft and survival rates than RSLT at 5 years: median 5-year patient survival was 92% with LDLT versus 65% for RSLT; graft survival was 81% with LDLT versus 63% with RSLT. Recipients of RSLT were more likely to experience vascular complications. RSLT grafts experienced a much longer ischaemic time than LDLT grafts. Registry data also showed lower patient and graft survival with RSLT in comparison with LDLT.
SLT versus LDLT (5 studies).
LDLT was associated with more favourable actuarial graft and patient survival rates at one year than SLT. However, no difference was found between the graft types at 5 years. The risk of graft dysfunction, blood loss, biliary and vascular complications, bowel perforation and bleeding from the cut liver surface was similar across both graft types.