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. 2022 Oct 28;10(5):814-824.
doi: 10.14218/JCTH.2021.00538. Epub 2022 Apr 6.

Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades

Saleh A Alqahtani  1 , Ahmet Gurakar  1 , Hani Tamim  2 , Thomas D Schiano  3 , Alan Bonder  4 , Zachary Fricker  4 , Marwan Kazimi  4 , Devin E Eckhoff  4 , Michael P Curry  4 , Behnam Saberi  4
Affiliations

Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades

Saleh A Alqahtani et al. J Clin Transl Hepatol. .

Abstract

Background and aims: Liver organ shortage remains a major health burden in the US, with more patients being waitlisted than the number of liver transplants (LTs) performed. This study investigated US national and regional trends in living donor LT (LDLT) and identified factors associated with recipient survival.

Methods: We retrospectively analyzed LDLT recipients and donors from the United Network Organ Sharing/Organ Procurement Transplant Network database from 1998 until 2019 for clinical characteristics, demographic differences, and survival rate. National and regional trends in LDLT, recipient outcomes, and predictors of survival were analyzed.

Results: Of the 223,571 candidates listed for an LT, 57.5% received an organ, of which only 4.2% were LDLTs. Annual adult LDLTs first peaked at 412 in 2001 but experienced a significant decline to 168 by 2009. LDLTs then gradually increased to 445 in 2019. Region 2 had the highest LDLT numbers (n=919), while region 1 had the highest proportion (11.1%). Overall, post-LT mortality was 21.4% among LDLT recipients. Post-LDLT survival rates after 1-, 5-, and 10-years were 92%, 87%, and 70%, respectively. Interval analysis (2004-2019) showed that patients undergoing LDLT in recent years had lower mortality than in earlier years (hazard ratio=0.81, 95% confidence interval=0.75-0.88).

Conclusions: Following a substantial decline after a peak in 2001, the number of adult LDLTs steadily increased from 2011 to 2019. However, LDLTs still constitute the minority of the transplant pool in the US. Life-saving policies to increase the use of LDLTs, particularly in regions of high organ demand, should be implemented.

Keywords: Liver transplantation; Living donor; Organ demand; Survival; UNOS.

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Conflict of interest statement

AB declares activities with Scientific Advisory Boards, Intercept, Primary Investigator for trials for Gilead and CARA. BS has been an editorial board member of Journal of Clinical and Translational Hepatology since 2016. All other authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. (A) Sankey diagram of the distribution of adult candidates who received an LDLT from 1998 to 2019 (OPTN data as of May 16, 2021). (B) Number of adult LDLTs per year in the United States from 1998 to 2019 (n=5,399). C) Percentage of adult LDLTs among all LTs per year in the United States from 1998 to 2019.
DDLT, deceased donor liver transplant; LT, liver transplant; LDLT, living donor liver transplant; OPTN, Organ Procurement and Transplantation Network.
Fig. 2
Fig. 2. (A) LDLTs as a percentage of total LTs in each United States OPTN region from 1998 to 2019. (B) Annual trend of adult LDLTs in each OPTN region from 1998 to 2019. (C) Annual trend of adult LDLTs as a percentage of all LTs by OPTN region from 1998 to 2019.
LDLT, living donor liver transplant; LT, liver transplant; OPTN, Organ Procurement and Transplantation Network.
Fig. 3
Fig. 3. (A) Adult LDLTs performed between 1998 and 2019 in the 25 with the most volume of transplants. (B) Annual trend in the total number of LDLTs per year in the 10 States with the most volume of transplants.
LDLT, living donor liver transplant.
Fig. 4
Fig. 4. Survival of LDLT recipients.
(A) From 2004 to 2019. (B) In era 1 (2004 to 2011) and era 2 (2012 to 2019). LDLT, living donor liver transplant.
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References

    1. Organ Procurement and Transplantation Network. National Data. 2021. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/
    1. Samji NS, Verma R, Satapathy SK. Magnitude of Nonalcoholic Fatty Liver Disease: Western Perspective. J Clin Exp Hepatol. 2019;9(4):497–505. doi: 10.1016/j.jceh.2019.05.001. - DOI - PMC - PubMed
    1. Kim PT, Testa G. Living donor liver transplantation in the USA. Hepatobiliary Surg Nutr. 2016;5(2):133–140. doi: 10.3978/j.issn.2304-3881.2015.06.01. - DOI - PMC - PubMed
    1. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91–96. doi: 10.1053/gast.2003.50016. - DOI - PubMed
    1. Parikh ND, Singal AG. Model for end-stage liver disease exception points for treatment-responsive hepatocellular carcinoma. Clin Liver Dis (Hoboken) 2016;7(5):97–100. doi: 10.1002/cld.545. - DOI - PMC - PubMed