Study Identifies Characteristics of Patients Likely to have a Potential Living Liver Donor

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New research published in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, reports that younger patients, those who are married, and those with Child-Pugh C disease—the most severe measure of liver disease—are more likely immigrants, divorced patients and those at the lowest income levels [and] were less likely to have a potential live donor volunteer for liver donation.
 
With a limited supply of deceased donor organs, livers from living donors provide a much needed, life-saving option for those with end-stage liver disease. Despite evidence suggesting that the 5-year recipient survival from the time of wait listing is estimated to be 20% higher with a live donor compared with deceased donor, living donor liver transplantation accounts for only a few percent in many Western countries.

“Given that the demand for liver transplantation is greater than the supply of deceased donor organs, there is an interest in increasing live donation at centers with experience in that method of transplantation,” explains lead author Dr. Eberhard Renner with the University Health Network and University of Toronto in Ontario, Canada. “Our study aims to identify recipient characteristics that are associated with having a living donor volunteer for donation.”

The research team reviewed data from 491 patients listed for liver transplantation at the University transplant center over a 24-month period. There were 245 patients identified who had a least one potential living donor with 70% of these recipients being male and having an average age of 53 years at wait listing. Hepatitis C, alcoholic liver disease and hepatocellular carcinoma were listed as reason for liver transplant in 34%, 20%, and 35% of cases in the study group.

Analyses found that recipients who had potential access to a living donor were more likely to have more severe liver disease (Child-Pugh C). The recipients were less likely to be older, single, divorced, immigrants or from the lowest income levels. Commenting about the findings Dr. Renner says, “More research is needed to understand and overcome the barriers to live donor liver transplants. Possible interventions like financial assistance and educational programs may help increase liver donation from living donors.”

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Access the full study on the Wiley Press Room here. (To access PDFs and embargoed stories you must be logged in to the Press Room before clicking the link. Request a login here.) Full citation: "Recipient Factors Associated with Having a Potential Live Liver Donor.” Adam Doyle, Rania N. Rabie, Arastoo Mokhtari, Mark Cattral, Anand Ghanekar, David Grant, Paul Greig, Gary Levy, Leslie Lilly, Ian McGilvray, Markus Selzner, Nazia Selzner and Eberhard L. Renner. Liver Transplantation; (DOI: 10.1002/lt.24148).

URL: http://doi.wiley.com/10.1022/lt.24148
Author Contact: Media wishing to speak with Dr. Renner may contact Alexandra Radkewycz with Toronto General Hospital, University Health Network at Alexandra.Radkewycz@uhn.ca.

About the Journal
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD and the ILTS, Liver Transplantation delivers current, peer-reviewed articles on surgical techniques, clinical investigations and drug research — the information necessary to keep abreast of this evolving specialty. For more information, please visit http://wileyonlinelibrary.com/journal/lt.

About Wiley
Wiley is a global provider of knowledge and knowledge-enabled services that improve outcomes in areas of research, professional practice and education. Through the Research segment, the Company provides digital and print scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising. The Professional Development segment provides digital and print books, online assessment and training services, and test prep and certification. In Education, Wiley provides education solutions including online program management services for higher education institutions and course management tools for instructors and students, as well as print and digital content.

Living Liver Donors Report Lower Sexual Function in Early Months Post-Surgery

Donor Education Pre-Transplant May Help Improve Recovery, Reduce Concerns

A new study found that sexual function in adult living donors was lower at the evaluation phase and at three months following liver transplantation. Results published in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, suggest that donor education prior to surgery may improve recovery and ease concerns about sexual function following the transplant.

Living liver donors provide a healthy portion of their liver to an individual with end-stage liver disease. These donors make a personal sacrifice to help save another individual from certain death. Much of the medical literature focuses on the health-related quality of life of donors, but limited evidence is available regarding sexual function. A prior single-center study found that nearly 50% of donors reported a worsening of sexual function one week to one month following donation, returning to normal at three months post-operation.

“To further knowledge in this important area, our study sought to identify the extent of sexual concerns for liver donors,” said lead author Dr. Andrea DiMartini with Western Psychiatric Institute and Clinic in Pittsburgh, Pa. “Our investigation examined sexual functioning of liver donors before and after donation using data from a multi-site investigation, known as the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL).

For this study the team examined the sexual function of 208 liver donors and any changes that may occur during the first year following donation using self-reported surveys. A group of 155 non-donors also completed the survey that included questions regarding sexual desire, satisfaction, orgasm, and erectile function in men.

Analyses show that donor sexual performance was lower at the time of evaluation and three months after transplant surgery than at one year following donation. Researchers found that during the early recovery phase, abdominal pain was linked to difficulty reaching orgasm; concerns over appearance was associated with lower sexual desire; and not feeling back to normal correlated to a dissatisfaction with sexual life.

Dr. DiMartini concludes, “The goal of all donor teams is to create a positive experience, both mentally and physically, and reduce stress for organ donors. Our findings suggest that providing more information to donors about what to expect with sexual function will help ease concerns and prepare themselves for the early days following liver transplant surgery.”

This study was funded in part by the National Institute of Diabetes & Digestive & Kidney Diseases (grants U01-DK62444, U01-DK62467, U01-DK62483, U01-DK62484, U01-DK62494, U01-DK62496, U01-DK62498, U01-DK62505, U01-DK62531, U01-DK085587, U01-DK85515, and U01-DK62536), the Health Resources and Services Administration (HRSA), and the American Society of Transplant Surgeons (ASTS).

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Access the full study on the Wiley Press Room here. (To access PDFs and embargoed stories you must be logged in to the Press Room before clicking the link. Request a login here.)
Full citation: “Patterns and Predictors of Sexual Function after Liver Donation: the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL).” AF DiMartini, MA Dew, Z Butt, MA Simpson, DP Ladner, AR Smith, P Hill-Callahan and BW Gillespie. Liver Transplantation; (DOI: 10.1002/lt.24108).

URL: http://doi.wiley.com/10.1022/lt.24108
Author Contact: Media wishing to speak with Dr. DiMartini may contact Jenya Abramovich with Arbor Research at jenya.abramovich@arborresearch.org.

About the Journal
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD and the ILTS, Liver Transplantation delivers current, peer-reviewed articles on surgical techniques, clinical investigations and drug research — the information necessary to keep abreast of this evolving specialty. For more information, please visit http://wileyonlinelibrary.com/journal/lt.

About Wiley
Wiley is a global provider of knowledge and knowledge-enabled services that improve outcomes in areas of research, professional practice and education. Through the Research segment, the Company provides digital and print scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising. The Professional Development segment provides digital and print books, online assessment and training services, and test prep and certification. In Education, Wiley provides education solutions including online program management services for higher education institutions and course management tools for instructors and students, as well as print and digital content.

HealthWise: Hepatitis C: Giving a Liver, Getting a Liver Lucinda K. Porter, RN

Years of living with chronic hepatitis C virus infection (HCV) destroyed my friend Rick’s liver. Last year, a liver transplant saved his life. A motor vehicle accident killed a 19-year-old man, and now Rick is healthy. Not a day passes, that Rick doesn’t say thank you for the life of the man whose liver restored Rick’s health.

The same year Rick received his liver, I lost three friends who would have lived had hepatitis C been diagnosed earlier and they could have had a chance at liver transplantation. Rick was incredibly fortunate to have received a liver, because there is a major organ shortage in the U.S. According to the American Liver Foundation, approximately 17,000 people are on the liver transplant list. Of these, 6000 people were transplanted; 1500 to 1700 people died before they could receive a liver.

Chronic liver failure caused by complications from HCV is the most common reason for adult liver transplantation in the United States. Cirrhosis caused by long-term alcohol abuse is the second leading cause. The majority of people living with HCV will never progress to the point where transplantation will be necessary. Liver transplantation is a complicated surgery, requiring lifelong follow-up care. Liver transplant patients have an approximately 86% one-year and 78% three-year survival rate.

Most liver transplants use deceased donors. However, the liver’s remarkable ability to regenerate allows us to use partial livers from living donors. A living donor doesn’t have to be a blood relative, but must have a compatible blood type. About 40% to 60% of the donor’s liver is removed. Within eight weeks, the livers of both the donor and the recipient are usually completely regenerated. The average donor recovers in about two months; recipients recover in roughly six to 12 months.

Although living liver transplantation sounds like the perfect way to address the organ shortage, it isn’t.  The potential risk to the donor is so high that live liver donations are done only when the potential risk to the donor is small and the potential benefit to the recipient is unquestionable. It is difficult to find current data on live liver transplantation, but it appears that there are 250 to 400 liver donor transplants a year. One in 300 donors die and about 30% suffer a complication. Many living donors who die are relatives of the recipients. One can only imagine how difficult it might be to live with the knowledge that you are alive, but your otherwise healthy donor is not. 

Although increasing the donor organ pool is important, a better plan is to reduce the organ demand. Screening, linkage to care, and treating hepatitis C patients will reduce the number of liver transplant procedures needed. When I began working in this field, hepatitis C patients who were transplanted would still have HCV. This meant the transplanted liver was reinfected, and in some cases, it too would progress to cirrhosis. Now we can cure hepatitis C, which greatly cuts down on the stress to the transplanted organ and diverts the need for a second transplant.

Other strategies that will reduce the demand for livers are:

• Immunizing all children against hepatitis B
• Implementing awareness programs to reduce liver-injury risk, such as from alcohol, drug, and dietary supplement use
• Raise awareness of the impact of diet on the liver. Fatty liver disease is on the rise in the U.S., which in turn causes a decrease in the number of viable livers.
• Increase the organ donor pool. For instance, countries that use an “opt-out” strategy have much higher donor rates. “Opt-out” means that everyone is a potential donor unless otherwise indicated. For instance, Germany uses an opt-in system and 12% of its population consents to donate. Neighboring Austria uses an opt-out system, and has a consent rate of nearly 100%. The U.S. uses an “opt-in” strategy.

In some cases, patients whose hepatitis C is cured, may be potential organ donors. This situation is considered if the organ is in good shape, and the recipient would otherwise die. The recipient is given the option to decline the HCV antibody-positive organ. Compared to HCV antibody-negative organs, the long-term survival rate in patients who received an HCV antibody-positive/viral load-negative organ are similar. So, if you are cured of HCV, celebrate by filling out your organ donor card. Ask family and friends to fill theirs out too.

Lucinda K. Porter, RN, is a long-time contributor to them HCV Advocate and author of Free from Hepatitis C and Hepatitis C One Step at a Time. Her blog is www.LucindaPorterRN.com

Additional Resources

• Donate Life America
  http://donatelife.net
• National Living
  Donor Assistance
  www.livingdonorassistance.org
• OrganDonor.gov
  www.organdonor.gov
• Organ Procurement and Transplant Network
  http://optn.transplant.hrsa.gov
• Transplant Living
  www.transplantliving.org
• United Network for Organ Sharing
  www.unos.org

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