Comparison of Vascular Complications Between Living-donor and Deceased-donor Liver Transplantation - A Systematic Review and Meta-analysis.

BACKGROUND

Vascular complications commonly cause graft loss and morbidity after liver transplantation (LT). Comparative data on the risk of vascular complications are limited. Hence, the present meta-analysis was conducted to analyze the difference in vascular complications between living-donor LT (LDLT) and deceased-donor LT (DDLT).

METHODS

A literature search of three databases was conducted for studies comparing the incidence of vascular complications with LDLT and DDLT. The event rates and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.

RESULTS

A total of 20 studies were included in the final analysis. There was no difference in the incidence of overall vascular complications (9.3%, 95% CI: 6.6-12.0 vs. 8.5%, 95% CI: 5.6-11.4) between LDLT and DDLT with OR 0.94 (95% CI: 0.73-1.21) (15 studies).There was a higher incidence of vascular complications with LDLT in older studies (published before 2013) but not in new studies. When comparing the individual complications, LDLT was associated with a higher incidence of hepatic artery thrombosis (HAT) (3.8%, 95% CI: 2.4-5.2 vs. 1.6%, 95% CI: 1.1-2.2)with OR 2.20 (95% CI: 1.53-3.17) (14 studies)and a significantly lower incidence of intra-abdominal bleeding(4.8%, 95% CI: 3.3-6.2 vs. 7.9%, 95% CI: 5.0-10.7) with OR 0.64 (95% CI: 0.47-0.87) (11 studies). However, there was no difference in the incidence (2.1%, 95% CI: 0.5-3.8 vs. 1.0%, 95% CI: 0.1-1.9) of portal vein thrombosis between LDLT and DDLT with OR 1.85 (95% CI: 0.82-4.18) (6 studies).

CONCLUSION

Despite a comparable risk of vascular complications between LDLT and DDLT, LDLT was associated with a higher risk of HAT and a lower risk of intraprocedural bleeding. Further studies are required to analyze the effect of donor-recipient characteristics and surgical techniques on the risk of vascular complications.