WAITLIST outcomes are improved by living donor liver transplantation (LDLT) for high-risk patients with cirrhosis, according to a recent study from the University Health Network, Toronto, Canada; University of Toronto, Canada; Baylor University Medical Center, Dallas, Texas; and Dow University of Health Sciences, Karachi, Pakistan.
Due to the increasing number of non-alcoholic steatohepatitis and comorbid disease burden in recent years, as well as older and frailer liver transplant candidates, patients are predisposed to poor waitlist outcomes. This study aimed to assess the impact of access to LDLT in waitlisted patients at highest risk of dropout.
The team reviewed adult patients with decompensated cirrhosis listed for liver transplant between November 2012–December 2018, and identified patients with potential living donor (pLD) available. They then performed survival analyses with Cox proportional hazard models and time to liver transplant with competing risk model, as well as prediction model development. A total of 860 patients met the inclusion criteria, of whom 360 (41.8%) had a pLD identified and 496 (57.6%) underwent liver transplant, 170 (34.2%) of which were LDLT. While pLD was beneficial for all patients, those with moderate to severe frailty at listing (interaction p=0.03), Model for End-Stage Liver Disease (MELD)-Na score <20 (interaction p<0.0001), and height <160 cm (interaction p=0.03), benefitted the most.
The researchers concluded that certain subgroups of patients who are at highest risk for waitlist mortality with prolonged waiting time, which represents a growing number of the waitlist population, would be especially protected against delisting or death if they have access to living donation, stating: “LDLT is beneficial to all, with improved waitlist mortality and post-transplant outcomes.”
