Abstract

Background:

Living donor liver transplantation (LDLT) has been increasing in the United States (US). While data exists on longer-term patient and graft outcomes, a contemporary analysis of short-term outcomes is needed to better understand risk factors and opportunities for improvement.

Methods:

Adult (≥18 years) LDLT recipients from January 2004 to December 2021 were analyzed from the United States Scientific Registry of Transplant Recipients (SRTR). Graft status at 30 days was assessed with graft failure defined as retransplantation or death. Bivariate analysis of continuous and categorical variables was performed, and a multivariable logistic regression was used to identify risk factors of early graft failure.

Results:

During the study period, 4,544 LDLTs were performed with a graft failure rate of 3.4% (155/4544) at 30 days. Grafts from male donors (aOR: 0.63, CI: 0.45-0.89, p=0.009), right lobe grafts (aOR: 0.41, CI: 0.27-0.62, p<0.001), older recipient age (aOR: 0.99, CI: 0.97-0.99, p=0.015), and higher recipient albumin (aOR: 0.73, CI: 0.57-0.93, p=0.011) were associated with superior early graft outcomes, whereas, Asian recipient race (vs. White; aOR: 3.37, CI: 1.98-7.07, p<0.001) and a history of recipient PVT (aOR: 2.7, CI: 1.52-4.77, p=0.001) were associated with inferior outcomes. LDLTs performed during the most recent 2016-2021 period (compared to 2004-2009 and 2010-2015) resulted in significantly superior outcomes (aOR: 0.45, p<0.001, CI: 0.23-0.69) (Table 1).

Conclusion:

Our study demonstrates that while short-term adult LDLT graft failure is uncommon, there are opportunities for optimizing outcomes by prioritizing right lobe donation, improving candidate nutritional status, and careful pretransplant risk assessment of candidates with known PVT. Notably, a period effect exists whereby increased LDLT experience in the most recent era correlated with improved outcomes.