Living donor liver transplantation (LDLT) is an attractive alternative to deceased donor liver transplantation (DDLT). Although both modalities have similar short-term outcomes, long-term outcomes are not well studied. Herein, we compared 20-year outcomes of 668 adults who received LDLT with1596 DDLT at the largest liver transplant (LT) program in Canada. Recipients of LDLT were significantly younger and more often male than DDLT (p<0.001). Autoimmune diseases were more frequent in LDLT, whereas viral hepatitis and alcohol-related liver disease in DDLT. LDLT recipients had lower MELD scores (P=.008), waited less (p<0.001), and were less often inpatient at the time of LT (P<0.001). In a non-adjusted analysis, 1-, 10-, and 20-year patient survival rates were significantly higher in LDLT (93%, 74%, and 56%) versus DDLT (91%, 67%, and 46%; log-rank P = 0.02), as were graft survival rates LDLT (91%, 67%, and 50%) versus (90%, 65%, and 44.3%, respectively, for DDLT; log-rank P = 0.31).

After multivariable adjustment, LDLT and DDLT were associated with a similar hazard of patient and graft survival. Our data of 20-years follow-up of LDLT from a single, large Western center demonstrates excellent long-term outcomes for recipients of LDLT.