Temporal evolution of living donor liver transplantation survival - A UNOS registry study.

ABSTRACT

Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. 7,257 LDLT recipients with a median age of 54years (IQR45,61), 54% male, 80% non-Hispanic White, BMI 26.3kg/m2 (IQR23.2,30.0), and MELD 15 (IQR11,19) were included. The median cold ischemic time was 1.6hours (IQR1.0,2.3) with 88% right-lobe-grafts. The follow-up was 4.0years (IQR1.0,9.2). The contemporary reached median overall survival was 17.0years (95%CI16.1,18.1) with OS estimates 1-year 95%, 3-years 89%, 5-years OS 84%, 10-years 72%, 15-years 56% and 20-years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (aHR 0.53; 95%CI0.39,0.71). The median center-caseload per year was 5 (IQR2,10) with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met.