Benefits of a Living Donor Liver Transplant (LDLT)
The current waiting period for a cadaveric donor liver is often too long to benefit patients with these rapidly progressive diseases. Without an LDLT, it is highly unlikely that these patients will receive a transplantation before they develop fatal complications.
Besides being an alternative source of donor livers, the other advantage of LDLT over cadaveric liver transplantation is that it allows scheduling of the procedure. As such, the patient with decompensated liver function can be optimised prior to the transplant surgery. In addition, the quality of the liver graft is better as it is retrieved from a healthy donor and the cold ischaemic time (the time the donated liver has no blood supply) is much shorter. The biggest disadvantage of LDLT is the potential for complications or even death of a healthy donor. There are limitations with LDLT, the foremost is finding a suitable compatible donor, who has the same blood group and is fit to undergo the surgery. The donor can be the next of kin, a relative or even a close friend.
Living Donor Liver Transplant at the Asian American Liver Cancer (AALC)
At AALC, LDLT for adults and children is performed by an experienced team of specialist doctors. For patients who have suitable donors, extremely stringent investigations for the donor and recipient are carried out to ensure the safety of both the donor and the optimal graft for the recipient.
Since performing its first living donor liver transplantation (LDLT) in 2002, AALC has successfully performed more than 230 LDLTs to-date with consistently good clinical outcomes – the first private medical centre in Asia to achieve this milestone. Today, it is one of Southeast Asia’s largest private liver centres, with a direct link to one of the world’s most recognised transplantation programmes through the University of Pittsburgh Medical Center.
Since the 1990s, LDLT is an accepted curative treatment modality for hepatocellular carcinoma (HCC). The Asian American Liver Centre has expanded the indication criteria of LDLT for HCC due to the substantial number of patients beyond the *Milan criteria (small or few tumours) with long term survival after LDLT.
*Milan criteria – 1 tumour <5cm or up to 3 tumours <3cm (NEJM 1996; 334)
**Beyond Milan criteria for AALC are:
NO extra hepatic disease
NO limitation number or size.
Among all patients transplanted since 2002 at AALC, there were 69% male and 31% female recipients. Survival outcomes for living donor liver transplantations in patients between 2008 – 2012 for 1 year, 3 years and 5 years were 88%, 75% and 69% respectively. Patients transplanted for acute liver failure and malignancy were included in this analysis.
Outcomes for Hepatocellular Carcinoma (HCC) Recipients
At least 98 LDLTs were performed for patients with HCC. Survival outcomes were compared for patients transplanted for HCC within and beyond the Milan criteria. Overall survival rates for HCC patients for 1 year, 3 years and 4 years were 86%, 72% and 64% respectively. For Milan criteria patients, the rates were 89%, 82% and 82% respectively.
AALC’s highly successful LDLT Programme is complemented by the Parkway Asian Transplant Unit (PATU) – a dedicated ward with Intensive Care Unit (ICU) facilities and state-of-the-art medical equipment including liver dialysis machines and monitoring devices. This ensures that every patient receives the best treatment for their specific liver condition.
You can learn more about liver transplant at the Asian American Liver Centre.
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