Living-Donor Liver Transplant and Improved Post-Transplant Survival in Patients with Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) is the leading indication of liver transplantation (LT) among autoimmune liver disease patients. There is a scarcity of studies comparing survival outcomes between living-donor liver transplants (LDLT)s and deceased-donor liver transplants (DDLTs) in this population. Using the United Network for Organ Sharing database, we compared 4679 DDLTs and 805 LDLTs. Our outcome of interest was post-LT patient survival and post-LT graft survival. A stepwise multivariate analysis was performed, adjusting for recipient age, gender, diabetes mellitus, ascites, hepatic encephalopathy, cholangiocarcinoma, hepatocellular carcinoma, race, and the model for end-stage liver disease (MELD) score; donor’ age and sex were also included to the analysis. According to univariate and multivariate analysis, LDLT had a patient and graft survival benefit compared to DDLT (HR, 0.77, 95% CI 0.65–0.92; p < 0.002). LDLT patient survival (95.2%, 92.6%, 90.1%, and 81.9%) and graft survival (94.1%, 91.1%, 88.5%, and 80.5%) at 1, 3, 5, and 10 years were significantly better than DDLT patient survival (93.2%, 87.6%, 83.3%, and 72.7%) and graft survival (92.1%, 86.5%, 82.1%, and 70.9%) (p < 0.001) in the same interval. Variables including donor and recipient age, male recipient gender, MELD score, diabetes mellitus, hepatocellular carcinoma, and cholangiocarcinoma were associated with mortality and graft failure in PSC patients. Interestingly, Asians were more protected than Whites (HR, 0.61; 95% CI, 0.35–0.99; p < 0.047), and cholangiocarcinoma was associated with the highest hazard of mortality (HR, 2.07; 95% CI, 1.71–2.50; p < 0.001) in multivariate analysis. LDLT in PSC patients were associated with greater post-transplant patient and graft survival compared to DDLT patients.

[1]  J. Pomposelli,et al.  Survival Benefit of Living-Donor Liver Transplant , 2022, JAMA surgery.

[2]  K. Zieniewicz,et al.  Long‐term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the European Liver Transplant Registry , 2021, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  T. Cotter,et al.  Living Donor Liver Transplantation in the United States: Evolution of Frequency, Outcomes, Center Volumes, and Factors Associated With Outcomes , 2021, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[4]  A. Israni,et al.  OPTN/SRTR 2019 Annual Data Report: Liver , 2021, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[5]  P. Thuluvath,et al.  Liver transplant waitlist removal, transplantation rates and post-transplant survival in Hispanics , 2020, PloS one.

[6]  S. Alexopoulos,et al.  Living vs deceased donor liver transplantation in cholestatic liver disease: An analysis of the OPTN database , 2020, Clinical transplantation.

[7]  T. Karlsen,et al.  Emerging therapies in primary sclerosing cholangitis: pathophysiological basis and clinical opportunities , 2020, Journal of Gastroenterology.

[8]  S. Nundy,et al.  Good Long-Term Outcomes in Patients With Primary Sclerosing Cholangitis Undergoing Living Donor Liver Transplantation. , 2020, Journal of clinical and experimental hepatology.

[9]  G. Gores,et al.  An update on primary sclerosing cholangitis epidemiology, outcomes and quantification of alkaline phosphatase variability in a population-based cohort , 2020, Journal of Gastroenterology.

[10]  A. Bonder,et al.  Increased Posttransplant Mortality for Autoimmune Hepatitis Compared With Other Autoimmune Liver Diseases , 2019, Journal of clinical gastroenterology.

[11]  N. Chandok,et al.  Primary sclerosing cholangitis: diagnostic and management challenges , 2017, Clinical and experimental gastroenterology.

[12]  A. Lok,et al.  Recurrent primary sclerosing cholangitis in the Adult‐to‐Adult Living Donor Liver Transplantation Cohort Study: Comparison of risk factors between living and deceased donor recipients , 2016, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[13]  Pedro M. Baptista,et al.  How important is donor age in liver transplantation? , 2016, World journal of gastroenterology.

[14]  J. Emond,et al.  Defining long-term outcomes with living donor liver transplantation in North America. , 2015, Annals of surgery.

[15]  B. French,et al.  Superior survival using living donors and donor‐recipient matching using a novel living donor risk index , 2014, Hepatology.

[16]  S. Hohmann,et al.  Comparing living donor and deceased donor liver transplantation: A matched national analysis from 2007 to 2012 , 2014, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[17]  T. Hong,et al.  Outcomes of living donor liver transplantation using elderly donors , 2014, Annals of surgical treatment and research.

[18]  Robert M Merion,et al.  Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era , 2011, Hepatology.

[19]  S. Halpern,et al.  Current Trends in Living Donor Liver Transplantation for Primary Sclerosing Cholangitis , 2011, Transplantation.

[20]  N. Kemmer Ethnic disparities in liver transplantation. , 2011, Gastroenterology & hepatology.

[21]  Rajeev Sharma,et al.  Living Donor and Deceased Donor Liver Transplantation for Autoimmune and Cholestatic Liver Diseases—An Analysis of the UNOS Database , 2010, Journal of Gastrointestinal Surgery.

[22]  Rajeev Sharma,et al.  Comparative Analysis of Outcomes in Living and Deceased Donor Liver Transplants for Primary Sclerosing Cholangitis , 2009, Journal of Gastrointestinal Surgery.

[23]  I. Ng,et al.  Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma , 2007, The British journal of surgery.

[24]  T. Karlsen,et al.  Primary sclerosing cholangitis , 2001, The Lancet.

[25]  C. Benz,et al.  [Primary sclerosing cholangitis]. , 2000, Der Internist.

[26]  See Related Editorial on Page X , 2022 .