Temporal evolution of living donor liver transplantation recipient outcomes – a UNOS registry study

Document Type

Conference Proceeding

Publication Date

5-16-2024

Publication Title

HPB (Oxford)

Abstract

Background: Living donor liver transplantation (LDLT) is a curative treatment option for several liver diseases and has the potential to eliminate the wait list duration and its associated mortality. We aim to evaluate (1) temporal changes of overall survival (OS), (2) independent predictors for mortality and (3) differences of risk factors over time. Methods: Adult LDLT patients from the United Network for Organ Sharing (UNOS) registry up to 2020 were included. Groups in 5 year intervals were formed. Kaplan-Meyer and multivariate stepwise backward elimination logistic regression analysis were performed. Results: 5,506 LDLT patients (median age 54.0years, 56% male, 81% non-Hispanic White, BMI 26.1kg/m2, 47% blood type O and MELD of 15 at time of transplant) were selected. The cold ischemic time was 1.5hours with in 86.4% a right lobe graft used. The median follow-up was 4.0years. The OS was significantly different between time periods (log-rank p<0.001) (Figure 1). Comparing 1996-2000 to 2016-2020 OS has relatively improved at 1-year by +13% and at 3-year by +17%. Temporal significant changes of the independent predictors for mortality of recipient and donor age, hepatocellular carcinoma with cirrhosis, cholangiocarcinoma, previous transplantation, creatinine, albumin, INR, encephalopathy and length of stay were noted. Conclusions: LDLT is a safe procedure with good short-, middle- and long-term survival rates. Its efficacy has significantly improved despite a temporal increase of risk parameters. These findings suggest that the limit for LDLT in the United States has yet to be met, as this evolving therapeutic option pushes its boundaries. [Formula presented]

Volume

26

First Page

S528-S529

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