# Comparative Outcomes of Living and Deceased Donor Liver Transplantation in Adults: A Systematic Review and Meta-Analysis

## TL;DR

This study compares living and deceased donor liver transplants in adults and finds similar long-term outcomes, though evidence is limited.

## Contribution

A systematic review and meta-analysis comparing LDLT and DDLT outcomes in adults using recent data.

## Key findings

- LDLT showed better 1- and 5-year patient and graft survival compared to DDLT, but evidence is low-certainty.
- No significant differences were found in 3-year survival, graft survival within 1 year, or complication rates between LDLT and DDLT.
- LDLT is a viable alternative in areas with limited deceased donor availability, but more high-quality studies are needed.

## Abstract

Background/Objectives: Living donor liver transplantation (LDLT) has emerged as an alternative to deceased donor liver transplantation (DDLT) in the circumstance of scarcity of deceased grafts. This systematic review and meta-analysis aims to compare outcomes between LDLT and DDLT in adult recipients. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A systematic literature search was performed using PubMed, EMBASE, and manual reference screening of relevant articles. We included peer-reviewed cohort studies comparing LDLT and DDLT in adult patients (≥18 years), published in English since 2015. Results: A total of 17 cohort studies, published between 2015 and 2024, fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. These studies included a total of 22,514 adult liver transplant recipients, of whom 3832 (17.02%) and 18,682 (82.98%) underwent LDLT and DDLT, respectively. In comparison with DDLT, LDLT was associated with better 1-year patient survival, 5-year patient survival, and 5-year graft survival; however, these findings are based on low-certainty evidence and may be influenced by selection bias and baseline differences between cohorts. There were no significant differences between LDLT and DDLT groups in 3-year patient survival, 1-year graft survival, re-transplantation rates, biliary leakage, biliary stricture, or infection rates. Conclusions: LDLT is a valuable alternative to DDLT, particularly in regions with limited access to deceased donor organs, as it provides an excellent alternative to DDLT without compromising recipient outcomes, though further high-quality studies are needed.