Living Donor Liver Transplantation for Alcohol-related Liver Disease: An Intention-to-treat Analysis
Recommended Citation
Magyar CTJ, Jones O, Rajendran L, Carrique L, Lynch MJ, Li Z, Claasen M, Ivanics T, Choi WJ, Gaviria F, Ghanekar A, Winter E, Bucur R, Shwaartz C, Reichman T, Sayed BA, Selzner M, Bhat M, Tsien C, Jaeckel E, Lilly LB, McGilvray ID, Cattral MS, Sapisochin G, and Selzner N. Living Donor Liver Transplantation for Alcohol-related Liver Disease: An Intention-to-treat Analysis. Transplantation 2025.
Document Type
Article
Publication Date
4-24-2025
Publication Title
Transplantation
Abstract
BACKGROUND: Alcohol-associated liver disease (ALD) is the leading indication for liver transplantation (LT) in the Western world. Although 6 mo of abstinence is no longer a criterion for patients with ALD, the outcomes of living donor LT (LDLT) versus deceased donor LT (DDLT) are not well established.
METHODSS: We performed an intention-to-treat analysis to evaluate the impact of listing and pursuing primary LDLT (pLDLT) compared with primary DDLT (pDDLT). The primary endpoint was overall survival from date of listing, evaluated using Cox regression (hazard ratios).
RESULTS: Two hundred thirty-three patients with ALD were listed for LT, of which 27 (12%) were pLDLT. The overall median model for end-stage liver disease (MELD) score at listing was 20 and Na-MELD 24, a median abstinence of 4.5 mo, and 128 (55%) underwent transplantation. There was no statistically significant adjusted difference at 3-y overall survival between pLDLT versus pDDLT (adjusted hazard ratio [HR] 0.72; P = 0.550) and in the as-treated analysis (HR 1.22; P = 0.741). No patients were delisted in the pLDLT group, whereas 86 (42%) patients were delisted in the pDDLT group; primarily because of death (46 [50%]) and medical improvement (24 [28%]). Alcohol use since the time of listing was documented in 29 (13%) patients; immortal time bias adjusted analysis found no significant difference between pLDLT and pDDLT (adjusted HR 1.07; P = 0.900) and the as-treated analysis (HR 2.95; P = 0.130).
CONCLUSIONS: Patients with ALD benefit from intention pLDLT with lower rates of waitlist dropout and delisting, attributable to mortality or medical deterioration, and should be encouraged to pursue this option.
Medical Subject Headings
Humans; Liver Transplantation/mortality/methods/adverse effects; Male; Female; Living Donors; Middle Aged; Intention to Treat Analysis; Adult; Liver Diseases; Alcoholic/surgery/mortality/diagnosis; Treatment Outcome; Waiting Lists/mortality; Proportional Hazards Models; Time Factors; Retrospective Studies; Risk Factors; Aged
PubMed ID
40269339
ePublication
ePub ahead of print
Volume
109
Issue
10
First Page
1601
Last Page
1610
