Hazard ratio trends among deceased liver transplant recipients in the United States, 2011-2016: A propensity score-matched study
Schilke R, Safwan M, Rizzari M, Collins K, Yoshida A, Nagai S, and Abouljoud M. Hazard ratio trends among deceased liver transplant recipients in the United States, 2011-2016: A propensity score-matched study. Transplantation 2018;102(7):S414.
Background: Donation after cardiac death (DCD) donor liver graft is a known risk factor for graft failure secondary to primary non-function (PNF) and/or diffuse cholangiopathy (DC). We used propensity score-matching (PSM) to study mortality and graft failure hazard ratio trends among DCD vs. donation after brain death (DBD) recipients. Methods: Retrospective data of adult recipients ≥18 years fromthe national United Network for Organ Sharing registry 2011-2016 were analyzed. Clinically significant donor, recipient, and operative characteristics were balanced among donor groups. All-cause mortality, all-cause graft failure, graft failure due to DC and PNF were estimated using Cox proportional hazards models. Results: Among a total of 29573 recipients, 1800 (6.09%) received DCD livers. Overall, DCD recipients should expect worse 2-year all-cause mortality, 2-year all-cause graft failure, 2-year graft failure due to DC, and 1-year graft failure due to PNF in comparison to DBD recipients (HR=1.43, 1.45, 7.87, and 2.56, respectively). Figure 1 presents trends in the crude and PSM hazard ratios of DCD vs. DBD recipients. All-cause mortality for both crude and PSM adjusted estimates, as well as all-cause graft failure, indicate declining trends (P=0.015, <0.001, <0.001, and 0.002, respectively). Whereas crude hazard trends for DC and PNF are statistically becoming worse for DCD recipients (P=0.002 and <0.001, respectively). Among the most recent time period (2015-2016): the hazard for all-cause mortality was null, 39%increased hazard for all-cause graft failure, 569% increased hazard for DC, and 176% increased hazard for PNF among DCD in comparison to DBD. Conclusions: All-cause PSM mortality and graft failure hazard declined from 2011 through 2016. Based on this trend future DCD and DBD recipients should expect identical two-year survival aswell as near similar graft function. However, we are observing more PNF recently among DCD recipients. Future data is required to confirm whether DC and PNF outcomes are improving or worsening over time amongst deceased liver transplant recipients.