Survival benefit of living donor availability in a large North American Center. An intention-to-treat analysis
Recommended Citation
Li Z, Magyar CT, Jones O, Claasen MP, Ivanics T, Bucur R, Rukavina N, Sayed BA, Selzner N, Ghanekar A, Cattral M, Sapisochin G. Survival benefit of living donor availability in a large North American Center. An intention-to-treat analysis. HPB (Oxford) 2024; 26:S65-S66.
Document Type
Conference Proceeding
Publication Date
5-16-2024
Publication Title
HPB (Oxford)
Keywords
adult, alcohol liver disease, conference abstract, diagnosis, end stage liver disease, female, hepatitis C, hospital admission, human, intention to treat analysis, liver transplantation, living donor, major clinical study, male, mortality, mortality risk, North American
Abstract
Background: Living-donor liver transplantation (LDLT) offers superior survival than staying on the waiting list, even at low MELD-Na of 11. We sought to evaluate the benefits of LDLT through an intention-to-treat-analysis from the time of listing. Methods: Liver transplant candidates listed at the University Health Network (2000-2021) were categorized as pLDLT (with a potential live donor who had undergone health screening) or pDDLT (without an identified live donor). Employing Cox proportional-hazard regression, we evaluated pLDLT’s survival impact through a risk-adjusted analysis (age, sex, MELD-Na at listing, primary etiology, presence of HCC). Furthermore, we assessed pLDLT’s effect across the spectrum of MELD-Na. Results: Of 4,553 candidates, 1,504 (33%) had potential living donors. Median age was 57 years, 68% were male and median MELD-Na was 15. Common etiologies included hepatitis C (29.5%) and alcoholic liver disease (29.1%), with 35.8% having HCC. The pDDLT group had a higher waitlist dropout (45%vs.21%, P<0.001) and waitlist mortality (19%vs.10%, P<0.001) overall, while the pLDLT group experienced a shorter median waiting time (4.8vs.6.2 months, P=0.003). The pLDLT group demonstrated superior survival outcomes at 1- (88.7%vs.82.4%), 5- (75.4%vs.64.4%), and 10-year (66.5%vs.54.5%) from listing (log-rank P<0.001)(Figure 1A) with a 36% reduced risk of death (adjusted hazard ratio 0.64, 95% CI 0.57-0.72, P<0.001). Moreover, predicted hazard ratios consistently remained below 1 across the MELD-Na range 12-39 (Figure 1B). Conclusion: Potential living donors enhance survival for end-stage liver disease patients with MELD-Na as low as 12, emphasizing LDLT's significance for those awaiting liver transplants. [Formula presented]
Volume
26
First Page
S65-S66
