Superior survival using living donors and donor-recipient matching using a novel living donor risk index

Authors

  • David S. Goldberg,

    Corresponding author
    1. Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
    3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
    • Address reprint requests to: David Goldberg, M.D., MSCE, Hospital of the University of Pennsylvania, Blockley Hall, 423 Guardian Dr., Rm. 703, Philadelphia, PA 19104. E-mail: david.goldberg@uphs.upenn.edu; fax: 215-349-5915.

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  • Benjamin French,

    1. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
    2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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  • Peter L. Abt,

    1. Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Kim Olthoff,

    1. Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Abraham Shaked

    1. Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Potential conflict of interest: Nothing to report.

  • David Goldberg supported by NIH K08 DK098272-01A1; David Goldberg, Kim Olthoff, and Abraham Shaked supported by NIH 5U01DK062494-12. This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Abstract

The deceased-donor organ supply in the U.S. has not been able to keep pace with the increasing demand for liver transplantation. We examined national Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) data from 2002-2012 to assess whether living donor liver transplantation (LDLT) has surpassed deceased donor liver transplantation (DDLT) as a superior method of transplantation, and used donor and recipient characteristics to develop a risk score to optimize donor and recipient selection for LDLT. From 2002-2012, there were 2,103 LDLTs and 46,674 DDLTs that met the inclusion criteria. The unadjusted 3-year graft survival for DDLTs was 75.5% (95% confidence interval [CI]: 75.1-76.0%) compared with 78.9% (95% CI: 76.9-80.8%; P < 0.001) for LDLTs that were performed at experienced centers (>15 LDLTs), with substantial improvement in LDLT graft survival over time. In multivariate models, LDLT recipients transplanted at experienced centers with either autoimmune hepatitis or cholestatic liver disease had significantly lower risks of graft failure (hazard ratio [HR]: 0.56, 95% CI: 0.37-0.84 and HR: 0.76, 95% CI: 0.63-0.92, respectively). An LDLT risk score that included both donor and recipient variables facilitated stratification of LDLT recipients into high, intermediate, and low-risk groups, with predicted 3-year graft survival ranging from >87% in the lowest risk group to <74% in the highest risk group. Conclusion: Current posttransplant outcomes for LDLT are equivalent, if not superior, to DDLT when performed at experienced centers. An LDLT risk score can be used to optimize LDLT outcomes and provides objective selection criteria for donor selection in LDLT. (Hepatology 2014;60:1717–1726)

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