Effect
Heal amount is increased by 75% of your Life per Kill.
Leech
Leech is a pure survival passive that returns Life per Hit and raises the healed amount by 75% of your Life per Kill. That makes it best suited to builds that strike fast and often, since the more individual hits you land, the more steadily the healing flows. Against dense packs the regeneration keeps you alive passively, without needing to trigger an active heal.
The slot is worth it when your build offers no other reliable sustain, or when you have a very high hit frequency – for example with channeled or rapid-firing builders. In the higher difficulty tiers, however, flat Life per Hit is often outpaced by percentage-based effects, so you'll mostly run this passive in mid-game phases or as a fallback against steady incoming damage.
Life per Kill becomes Life per Hit
The second sentence of the description is the more interesting one: the healed amount rises by 75% of your Life per Kill. A stat that otherwise only works on kills thereby flows into every single hit. The more Life per Kill your gear provides, the stronger Leech becomes; the base value of 18,507 Life per Hit is just the starting point.
Shadow Power works on the same principle, but only for 5 seconds after activation. Leech, by contrast, runs permanently and costs no Discipline. If you use both, you layer Shadow Power's temporary healing on top of the passive's constant baseline.
Leech only unlocks at level 60.
Skills with many hits
The passive rewards a high hit count. Channeled skills like Rapid Fire shoot in quick succession and land many individual hits per second. Chakram with the Shuriken Cloud rune hits nearby enemies every second automatically, even while you move. Skills with few but very hard hits benefit less, since you heal only once per hit; for them a different source of healing is usually the better choice.