Living donor liver transplantation improves waitlist outcomes in high-risk cirrhosis patients

Reviewed by Megan Craig, M.Sc.Sep 26 2023

A new research paper was published in Aging (listed by MEDLINE/PubMed as "Aging (Albany NY)" and "Aging-US" by Web of Science) Volume 15, Issue 17, entitled, "Availability of living donor optimizes timing of liver transplant in high-risk waitlisted cirrhosis patients."

Liver transplant (LT) candidates have become older and frailer. Growing non-alcoholic steatohepatitis (NASH) and comorbid disease burden in recent years is also predisposing them for poor waitlist outcomes. In this new study, researchers Fakhar Ali Qazi Arisar, Shiyi Chen, Catherine Chen, Noorulsaba Shaikh, Ravikiran Sindhuvalada Karnam, Wei Xu, Sumeet K. Asrani, Zita Galvin, Gideon Hirschfield, Keyur Patel, Cynthia Tsien, Nazia Selzner, Mark Cattral, Leslie Lilly, and Mamatha Bhat from the University Health Network, University of Toronto, Baylor University Medical Center, and Dow University of Health Sciences aimed to evaluate the impact of access to living donor liver transplantation (LDLT) in waitlisted patients at highest risk of dropout.

"We reviewed all adult patients with decompensated cirrhosis listed for LT from November 2012 to December 2018."

Patients with a potential living donor (pLD) available were identified. Survival analyses with Cox Proportional Hazards models and time to LT with Competing risk models were performed followed by prediction model development. Out of 860 patients who met inclusion criteria, 360 (41.8%) had a pLD identified and 496 (57.6%) underwent LT, out of which 170 (34.2%) were LDLT. The benefit of pLD was evident for all, but patients with moderate to severe frailty at listing (interaction p = 0.03), height <160 cm (interaction p = 0.03), and Model for end-stage liver disease (MELD)-Na score <20 (interaction p < 0.0001) especially benefited.

"Our study identifies that certain patient subgroups (short stature, MELD <20, and moderate to severe frailty) are at the highest risk for waitlist mortality with prolonged waiting time for a deceased donor organ offer. These patient subgroups, which represent a growing share of the waitlist population in recent years, would be especially protected against death or delisting if they had access to living donation at the time of listing. Certainly, LDLT is beneficial to all, with improved waitlist mortality and post-transplant outcomes."