Clinical outcomes after transplantation of domino grafts or standard deceased donor livers: a systematic review and meta-analysis.
Author
Parente, AlessandroMilana, Flavio
Hajibandeh, Shahin
Hajibandeh, Shahab
Tirotta, Fabio
Cho, Hwui-Dong
Kasahara, Mureo
Kim, Ki-Hun
Schlegel, Andrea
Publication date
2024-01-16
Metadata
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Background and aim: Domino liver transplantation (DLT) utilizes otherwise discarded livers as donor grafts for another recipients. It is unclear whether DLT has less favorable outcomes compared to deceased donor liver transplantation (DDLT). We aimed to assess the outcomes of DLT compared to DDLT. Methods: MEDLINE, Embase, and Web of Science database were searched to identify studies comparing outcomes after DLT with DDLT. Data were pooled using random-effects modeling, evaluating odds ratios (OR) or mean difference (MD) for outcomes including waiting list time, severe hemorrhage, intensive care unit (ICU), length hospital stay (LOS), rejection, renal, vascular, and biliary events, and recipient survival at 1, 3, 5, and 10 years. Results: Five studies were identified including 945 patients (DLT = 409, DDLT = 536). The DLT recipients were older compared to the DDLT group (P = 0.04), and both cohorts were comparable regarding lab MELD, hepatocellular carcinoma, and waitlist time. There were no differences in vascular (OR: 1.60, P = 0.39), renal (OR: 0.62, P = 0.24), biliary (OR: 1.51, P = 0.21), severe hemorrhage (OR: 1.09, P = 0.86), rejection (OR: 0.78, P = 0.51), ICU stay (MD: 0.50, P = 0.21), or LOS (MD: 1.68, P = 0.46) between DLT and DDLT. DLT and DDLT were associated with comparable 1-year (78.9% vs 80.4%; OR: 1.03, P = 0.89), 3-year (56.2% vs 54.1%; OR: 1.35, P = 0.07), and 10-year survival (6.5% vs 8.5%; OR: 0.8, P = 0.67) rates. DLT was associated with higher 5-year survival (41.6% vs 36.4%; OR: 1.70; P = 0.003) compared to DDLT, which was not confirmed at sensitivity analysis. Conclusion: This meta-analysis of the best available evidence (Level 2a) demonstrated that DLT and DDLT have comparable outcomes. As indications for liver transplantation expand, future high-quality research is encouraged to increase the DLT numbers in clinical practice, serving the growing waiting list candidates, with the caveat of uncertain de novo disease transmission risks.Citation
Parente A, Milana F, Hajibandeh S, Hajibandeh S, Tirotta F, Cho HD, Kasahara M, Kim KH, Schlegel A. Clinical outcomes after transplantation of domino grafts or standard deceased donor livers: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2024 Jan 16. doi: 10.1111/jgh.16476.Type
ArticleAdditional Links
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-1746PMID
38228293Publisher
Wileyae974a485f413a2113503eed53cd6c53
10.1111/jgh.16476