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Living Donor Availability Improves Patient Survival in a North American Center: An Intention-to-treat Analysis.
Li, Zhihao; Jones, Owen; Magyar, Christian T J; Claasen, Marco P A W; Ivanics, Tommy; Choi, Woo Jin; Rajendran, Luckshi; Winter, Erin; Bucur, Roxana; Rukavina, Nadia; Jaeckel, Elmar; Selzner, Nazia; Sayed, Blayne A; Ghanekar, Anand; Cattral, Mark; Sapisochin, Gonzalo.
Afiliação
  • Li Z; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Jones O; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Magyar CTJ; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Claasen MPAW; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
  • Ivanics T; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Choi WJ; Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
  • Rajendran L; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Winter E; Department of Surgery, Henry Ford Hospital, Detroit, Michigan, United States of America.
  • Bucur R; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
  • Rukavina N; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Jaeckel E; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Selzner N; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Sayed BA; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Ghanekar A; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Cattral M; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
  • Sapisochin G; HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
Ann Surg ; 2024 Jul 23.
Article em En | MEDLINE | ID: mdl-39041223
ABSTRACT

OBJECTIVE:

Assess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis.

BACKGROUND:

Living-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11.

METHODS:

Liver transplant candidates listed at the Ajmera Transplant Centre (2000-2021) were categorized as pLDLT (having a potential living donor) or pDDLT (without a living donor). Employing Cox proportional-hazard regression with time-dependent covariates, we evaluated pLDLT's impact on waitlist dropout and overall survival through a risk-adjusted analysis.

RESULTS:

Of 4,124 candidates, 984 (24%) had potential living donors. The pLDLT group experienced significantly lower overall waitlist dropouts (5.2%vs. 34.4%, P<0.001) and mortality (3.8%vs. 24.4%, P<0.001) compared to the pDDLT group. Possessing a living donor correlated with a 26% decline in the risk of waitlist dropout (adjusted hazard ratio 0.74, 95%CI 0.55-0.99, P=0.042). The pLDLT group also demonstrated superior survival outcomes at 1- (84.9%vs. 80.1%), 5- (77.6%vs. 61.7%), and 10-year (65.6%vs.52.9%) from listing (log-rank P<0.001) with a 35% reduced risk of death (adjusted hazard ratio 0.65, 95%CI 0.56-0.76, P<0.001). Moreover, the predicted hazard ratios consistently remained below 1 across the MELD-Na range 11-26.

CONCLUSIONS:

Having a potential living donor significantly improves survival in end-stage liver disease patients, even with MELD-Na scores as low as 11. This emphasizes the need to promote awareness and adoption of LDLT in liver transplant programs worldwide.

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article