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Low utilization of adult-to-adult LDLT in Western countries despite excellent outcomes: International multicenter analysis of the US, the UK, and Canada

Published:September 25, 2022DOI:https://doi.org/10.1016/j.jhep.2022.07.035

      Highlights

      • Living donor liver transplantation use is low in Western countries.
      • Despite this, long-term survival after living donor liver transplantation is excellent.
      • Continued efforts to increase use of living donor liver transplantation are warranted.

      Background & Aims

      Adult-to-adult living donor liver transplantation (LDLT) offers an opportunity to decrease the liver transplant waitlist and reduce waitlist mortality. We sought to compare donor and recipient characteristics and post-transplant outcomes after LDLT in the US, the UK, and Canada.

      Methods

      This is a retrospective multicenter cohort-study of adults (≥18-years) who underwent primary LDLT between Jan-2008 and Dec-2018 from three national liver transplantation registries: United Network for Organ Sharing (US), National Health Service Blood and Transplantation (UK), and the Canadian Organ Replacement Registry (Canada). Patients undergoing retransplantation or multi-organ transplantation were excluded. Post-transplant survival was evaluated using the Kaplan-Meier method, and multivariable adjustments were performed using Cox proportional-hazards models with mixed-effect modeling.

      Results

      A total of 2,954 living donor liver transplants were performed (US: n = 2,328; Canada: n = 529; UK: n = 97). Canada has maintained the highest proportion of LDLT utilization over time (proportion of LDLT in 2008 – US: 3.3%; Canada: 19.5%; UK: 1.7%; p <0.001 – in 2018 – US: 5.0%; Canada: 13.6%; UK: 0.4%; p <0.001). The 1-, 5-, and 10-year patient survival was 92.6%, 82.8%, and 70.0% in the US vs. 96.1%, 89.9%, and 82.2% in Canada vs. 91.4%, 85.4%, and 66.7% in the UK. After adjustment for characteristics of donors, recipients, transplant year, and treating transplant center as a random effect, all countries had a non-statistically significantly different mortality hazard post-LDLT (Ref US: Canada hazard ratio 0.53, 95% CI 0.28–1.01, p = 0.05; UK hazard ratio 1.09, 95% CI 0.59–2.02, p = 0.78).

      Conclusions

      The use of LDLT has remained low in the US, the UK and Canada. Despite this, long-term survival is excellent. Continued efforts to increase LDLT utilization in these countries may be warranted due to the growing waitlist and differences in allocation that may disadvantage patients currently awaiting liver transplantation.

      Lay summary

      This multicenter international comparative analysis of living donor liver transplantation in the United States, the United Kingdom, and Canada demonstrates that despite low use of the procedure, the long-term outcomes are excellent. In addition, the mortality risk is not statistically significantly different between the evaluated countries. However, the incidence and risk of retransplantation differs between the countries, being the highest in the United Kingdom and lowest in the United States.

      Graphical abstract

      Keywords

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      References

        • Olthoff K.M.
        • Merion R.M.
        • Ghobrial R.M.
        • Abecassis M.M.
        • Fair J.H.
        • Fisher R.A.
        • et al.
        Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium.
        Ann Surg. 2005; 242 (discussion 323-5): 314-323
        • Rela M.
        • Rammohan A.
        Why are there so many liver transplants from living donors in Asia and so few in Europe and the US?.
        J Hepatol. 2021; https://doi.org/10.1016/j.jhep.2021.05.036
        • Goto T.
        • Ivanics T.
        • Cattral M.S.
        • Reichman T.
        • Ghanekar A.
        • Sapisochin G.
        • et al.
        Superior long-term outcomes of adult living donor liver transplantation: a cumulative single-center cohort study with 20 years of follow-up.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2022; 28: 834-842https://doi.org/10.1002/lt.26386
        • Northup P.G.
        • Intagliata N.M.
        • Shah N.L.
        • Pelletier S.J.
        • Berg C.L.
        • Argo C.K.
        Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End-Stage Liver Disease (MELD) inflation.
        Hepatology. 2015; https://doi.org/10.1002/hep.27283
        • Soin A.S.
        • Chaudhary R.J.
        • Pahari H.
        • Pomfret E.A.
        A worldwide survey of live liver donor selection policies at 24 centers with a combined experience of 19 009 adult living donor liver transplants.
        Transplantation. 2019; 103: e39-e47https://doi.org/10.1097/TP.0000000000002475
        • Emamaullee J.
        • Conrad C.
        • Kim M.
        • Goldbeck C.
        • Kwon Y.
        • Singh P.
        • et al.
        Assessment of the global practice of living donor liver transplantation.
        Transpl Int Off J Eur Soc Organ Transpl. 2021; https://doi.org/10.1111/tri.13960
        • Manas D.
        • Burnapp L.
        • Andrews P.A.
        Summary of the British Transplantation Society UK guidelines for living donor liver transplantation.
        Transplantation. 2016; 100: 1184-1190https://doi.org/10.1097/TP.0000000000001128
        • Miller C.M.
        • Durand F.
        • Heimbach J.K.
        • Kim-Schluger L.
        • Lee S.-G.
        • Lerut J.
        • et al.
        The international liver transplant society guideline on living liver donation.
        Transplantation. 2016; 100: 1238-1243https://doi.org/10.1097/TP.0000000000001247
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gotzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349https://doi.org/10.1016/j.jclinepi.2007.11.008
        • Dickinson D.M.
        • Bryant P.C.
        • Williams M.C.
        • Levine G.N.
        • Li S.
        • Welch J.C.
        • et al.
        Transplant data: sources, collection, and caveats.
        Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2004; 4: 13-26https://doi.org/10.1111/j.1600-6135.2004.00395.x
        • Brahmania M.
        • Marquez V.
        • Kneteman N.M.
        • Bhat M.
        • Marleau D.
        • Wong P.
        • et al.
        Canadian liver transplant allocation for hepatocellular carcinoma.
        J Hepatol. 2019; 71: 1058-1060https://doi.org/10.1016/j.jhep.2019.07.016
        • CIHI. Canadian Institute for Health Information
        Canadian organ replacement register: methodological notes and supplementary information, 2009 to 2018.
        2019
        • NHS
        NHS blood and transplant organ donation and transplantation directorate liver advisory group: provision of standard data sets for liver transplant.
        2015
        • Kamath P.S.
        • Wiesner R.H.
        • Malinchoc M.
        • Kremers W.
        • Therneau T.M.
        • Kosberg C.L.
        • et al.
        A model to predict survival in patients with end-stage liver disease.
        Hepatology. 2001; 33: 464-470https://doi.org/10.1053/jhep.2001.22172
        • Roberts M.S.
        • Angus D.C.
        • Bryce C.L.
        • Valenta Z.
        • Weissfeld L.
        Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2004; 10: 886-897https://doi.org/10.1002/lt.20137
        • Varadhan R.
        • Weiss C.O.
        • Segal J.B.
        • Wu A.W.
        • Scharfstein D.
        • Boyd C.
        Evaluating health outcomes in the presence of competing risks: a review of statistical methods and clinical applications.
        Med Care. 2010; 48: S96-S105https://doi.org/10.1097/MLR.0b013e3181d99107
        • Zhang X.
        • Zhang M.-J.
        • Fine J.
        A proportional hazards regression model for the subdistribution with right-censored and left-truncated competing risks data.
        Stat Med. 2011; 30: 1933-1951https://doi.org/10.1002/sim.4264
        • Asrani S.K.
        • Kim W.R.
        • Edwards E.B.
        • Larson J.J.
        • Thabut G.
        • Kremers W.K.
        • et al.
        Impact of the center on graft failure after liver transplantation.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2013; 19: 957-964https://doi.org/10.1002/lt.23685
        • Goldberg D.S.
        • French B.
        • Abt P.L.
        • Olthoff K.
        • Shaked A.
        Superior survival using living donors and donor-recipient matching using a novel living donor risk index.
        Hepatology. 2014; 60: 1717-1726https://doi.org/10.1002/hep.27307
        • Lee S.-G.
        • Song G.-W.
        • Yoon Y.-I.
        An exceptional series: 5000 living donor liver transplantations at Asan Medical Center, Seoul, Korea.
        Transplantation. 2019; 103: 1739-1741https://doi.org/10.1097/TP.0000000000002708
        • Kim J.M.
        • Kim D.G.
        • Kim J.
        • Lee K.
        • Lee K.-W.
        • Ryu J.H.
        • et al.
        Outcomes after liver transplantation in Korea: incidence and risk factors from Korean transplantation registry.
        Clin Mol Hepatol. 2021; https://doi.org/10.3350/cmh.2020.0292
        • Petrowsky H.
        • Kim K.-H.
        • Tokat Y.
        Editorial: living-donor liver transplantation: why the Sun rises in the East and sets in the West?.
        Curr Opin Organ Transpl. 2019; 24: 620-622https://doi.org/10.1097/MOT.0000000000000700
        • Mokdad A.A.
        • Lopez A.D.
        • Shahraz S.
        • Lozano R.
        • Mokdad A.H.
        • Stanaway J.
        • et al.
        Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis.
        BMC Med. 2014; 12: 145https://doi.org/10.1186/s12916-014-0145-y
        • Lo C.-M.
        Deceased donation in Asia: challenges and opportunities.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2012; 18: S5-S7https://doi.org/10.1002/lt.23545
        • Chen C.-L.
        • Kabiling C.S.
        • Concejero A.M.
        Why does living donor liver transplantation flourish in Asia?.
        Nat Rev Gastroenterol Hepatol. 2013; 10: 746-751https://doi.org/10.1038/nrgastro.2013.194
        • Narasimhan G.
        • Kota V.
        • Rela M.
        Liver transplantation in India.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2016; 22: 1019-1024https://doi.org/10.1002/lt.24459
        • Abu-Gazala S.
        • Olthoff K.M.
        Status of adult living donor liver transplantation in the United States: results from the adult-to-adult living donor liver transplantation cohort study.
        Gastroenterol Clin North Am. 2018; 47: 297-311https://doi.org/10.1016/j.gtc.2018.01.004
        • Lo C.M.
        • Fan S.T.
        • Liu C.L.
        • Chan S.C.
        • Ng I.O.-L.
        • Wong J.
        Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma.
        Br J Surg. 2007; 94: 78-86https://doi.org/10.1002/bjs.5528
        • Merion R.M.
        • Shearon T.H.
        • Berg C.L.
        • Everhart J.E.
        • Abecassis M.M.
        • Shaked A.
        • et al.
        Hospitalization rates before and after adult-to-adult living donor or deceased donor liver transplantation.
        Ann Surg. 2010; 251: 542-549https://doi.org/10.1097/SLA.0b013e3181ccb370
        • Barbetta A.
        • Aljehani M.
        • Kim M.
        • Tien C.
        • Ahearn A.
        • Schilperoort H.
        • et al.
        Meta-analysis and meta-regression of outcomes for adult living donor liver transplantation versus deceased donor liver transplantation.
        Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2020; https://doi.org/10.1111/ajt.16440
        • Wong T.C.L.
        • Ng K.K.C.
        • Fung J.Y.Y.
        • Chan A.A.C.
        • Cheung T.-T.
        • Chok K.S.H.
        • et al.
        Long-term survival outcome between living donor and deceased donor liver transplant for hepatocellular carcinoma: intention-to-treat and propensity score matching analyses.
        Ann Surg Oncol. 2019; 26: 1454-1462https://doi.org/10.1245/s10434-019-07206-0
        • Goldaracena N.
        • Gorgen A.
        • Doyle A.
        • Hansen B.E.
        • Tomiyama K.
        • Zhang W.
        • et al.
        Live donor liver transplantation for patients with hepatocellular carcinoma offers increased survival vs. deceased donation.
        J Hepatol. 2019; 70: 666-673https://doi.org/10.1016/j.jhep.2018.12.029
        • Silverstein J.
        • Yao F.Y.
        • Grab J.D.
        • Braun H.J.
        • Roberts J.
        • Dodge J.L.
        • et al.
        National experience with living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC).
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2022; https://doi.org/10.1002/lt.26439
        • Barbas A.S.
        • Goldaracena N.
        • Dib M.J.
        • Al-Adra D.P.
        • Aravinthan A.D.
        • Lilly L.B.
        • et al.
        Early intervention with live donor liver transplantation reduces resource utilization in NASH: the Toronto experience.
        Transpl Direct. 2017; 3: e158https://doi.org/10.1097/TXD.0000000000000674
        • Humar A.
        • Ganesh S.
        • Jorgensen D.
        • Tevar A.
        • Ganoza A.
        • Molinari M.
        • et al.
        Adult living donor versus deceased donor liver transplant (LDLT versus DDLT) at a single center: time to change our paradigm for liver transplant.
        Ann Surg. 2019; 270: 444-451https://doi.org/10.1097/SLA.0000000000003463
        • Muzaale A.D.
        • Dagher N.N.
        • Montgomery R.A.
        • Taranto S.E.
        • McBride M.A.
        • Segev D.L.
        Estimates of early death, acute liver failure, and long-term mortality among live liver donors.
        Gastroenterology. 2012; 142: 273-280https://doi.org/10.1053/j.gastro.2011.11.015
        • Cotter T.G.
        • Paul S.
        • Sandikci B.
        • Couri T.
        • Bodzin A.S.
        • Little E.C.
        • et al.
        Increasing utilization and excellent initial outcomes following liver transplant of hepatitis C virus (HCV)-Viremic donors into HCV-negative recipients: outcomes following liver transplant of HCV-viremic donors.
        Hepatology. 2019; 69: 2381-2395https://doi.org/10.1002/hep.30540
        • UNOS
        The most active living donor liver transplant programs.
        2020
        • Tran L.
        • Humar A.
        Expanding living donor liver transplantation in the Western world: changing the paradigm.
        Dig Med Res. December 2020; 3 (Dig Med Res 2020)
        • Humar A.
        • Hughes C.
        • Mazariegos G.
        • Soltys K.
        • Gallatin A.
        • Emmett K.
        • et al.
        Growing LDLT volumes at a US center- what does it take to do over 100 LDLTs per year (abstract from the 2021 American Transplant Congress).
        Am J Transpl. 2021; 21
        • Kollmann D.
        • Sapisochin G.
        • Goldaracena N.
        • Hansen B.E.
        • Rajakumar R.
        • Selzner N.
        • et al.
        Expanding the donor pool: donation after circulatory death and living liver donation do not compromise the results of liver transplantation.
        Liver Transpl. 2018; https://doi.org/10.1002/lt.25068
        • Shah S.A.
        • Levy G.A.
        • Adcock L.D.
        • Gallagher G.
        • Grant D.R.
        Adult-to-adult living donor liver transplantation.
        Can J Gastroenterol. 2006; 20: 339-343https://doi.org/10.1155/2006/320530
        • Sapisochin G.
        • Goldaracena N.
        • Laurence J.M.
        • Dib M.
        • Barbas A.
        • Ghanekar A.
        • et al.
        The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: a prospective validation study.
        Hepatology. 2016; 64: 2077-2088https://doi.org/10.1002/hep.28643
        • (NHSBT) NB and T
        Annual report on liver transplantation.
        2020: 14
        • Taylor R.
        • Allen E.
        • Richards J.A.
        • Neuberger J.
        • Collett D.
        • Pettigrew G.J.
        Survival advantage for patients accepting the offer of a circulatory death liver transplant.
        J Hepatol. 2019; : 855-865
        • Rössler F.
        • Sapisochin G.
        • Song G.
        • Lin Y.-H.
        • Simpson M.A.
        • Hasegawa K.
        • et al.
        Defining benchmarks for major liver surgery: a multicenter analysis of 5202 living liver donors.
        Ann Surg. 2016; 264: 492-500https://doi.org/10.1097/SLA.0000000000001849
        • BTS; BASL
        Living donor liver transplantation: British Transplantation Society.
        2015
        • Nadalin S.
        • Capobianco I.
        • Panaro F.
        • Di Francesco F.
        • Troisi R.
        • Sainz-Barriga M.
        • et al.
        Living donor liver transplantation in Europe.
        Hepatobiliary Surg Nutr. 2016; 5: 159-175https://doi.org/10.3978/j.issn.2304-3881.2015.10.04
      1. (NHSBT) NB and T. National Liver offering scheme n.d. https://www.odt.nhs.uk/odt-structures-and-standards/odt-hub-programme/national-liver-offering-scheme/ (accessed August 1, 2021).

        • Walsh F.
        Organ donor law change named after Max and Keira.
        BBC, 2019 (Organ donor law change named after Max and Keira)
        Date accessed: August 1, 2021
        • Nasralla D.
        • Coussios C.C.
        • Mergental H.
        • Akhtar M.Z.
        • Butler A.J.
        • Ceresa C.D.L.
        • et al.
        A randomized trial of normothermic preservation in liver transplantation.
        Nature. 2018; https://doi.org/10.1038/s41586-018-0047-9
        • Mergental H.
        • Laing R.W.
        • Kirkham A.J.
        • Perera M.T.P.R.
        • Boteon Y.L.
        • Attard J.
        • et al.
        Transplantation of discarded livers following viability testing with normothermic machine perfusion.
        Nat Commun. 2020; 11: 2939https://doi.org/10.1038/s41467-020-16251-3
        • Berg C.L.
        • Merion R.M.
        • Shearon T.H.
        • Olthoff K.M.
        • Brown R.S.J.
        • Baker T.B.
        • et al.
        Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era.
        Hepatology. 2011; 54: 1313-1321https://doi.org/10.1002/hep.24494
        • Kwong A.J.
        • Kim W.R.
        • Lake J.R.
        • Smith J.M.
        • Schladt D.P.
        • Skeans M.A.
        • et al.
        OPTN/SRTR 2019 annual data report: liver.
        Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2021; 21: 208-315https://doi.org/10.1111/ajt.16494
        • Smith J.M.
        • Weaver T.
        • Skeans M.A.
        • Horslen S.P.
        • Harper A.M.
        • Snyder J.J.
        • et al.
        OPTN/SRTR 2016 annual data report: intestine.
        Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2018; 18: 254-290https://doi.org/10.1111/ajt.14560
        • OPTN
        Heart chapter: 2010 SRTR & OPTN annual data report.
        Sci Regist Transpl Recip. 2009; : 89-106
        • NHS
        Annual report on liver transplantation report for 2015/2016.
        2016
        • NHS
        Annual report on liver transplantation United Kingdom National Health Service report for 2018/2019 2019.
        2019
        • NHS
        Annual report on liver transplantation: report for 2017/2018.
        2018
        • Cotter T.G.
        • Minhem M.
        • Wang J.
        • Peeraphatdit T.
        • Ayoub F.
        • Pillai A.
        • et al.
        Living-donor liver transplantation in the United States: evolution of frequency, outcomes, center volumes and factors associated with outcomes.
        Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2021; https://doi.org/10.1002/lt.26029
        • Shah S.A.
        • Levy G.A.
        • Greig P.D.
        • Smith R.
        • McGilvray I.D.
        • Lilly L.B.
        • et al.
        Reduced mortality with right-lobe living donor compared to deceased-donor liver transplantation when analyzed from the time of listing.
        Am J Transpl Off J Am Soc Transpl Am Soc Transpl Surg. 2007; 7: 998-1002https://doi.org/10.1111/j.1600-6143.2006.01692.x
        • Gorgen A.
        • Goldaracena N.
        • Zhang W.
        • Rosales R.
        • Ghanekar A.
        • Lilly L.
        • et al.
        Surgical complications after right hepatectomy for live liver donation: largest single-center western world experience.
        Semin Liver Dis. 2018; 38: 134-144https://doi.org/10.1055/s-0038-1636932
        • Patel M.S.
        • Egawa H.
        • Kwon Y.K.
        • Chok K.S.H.
        • Spiro M.
        • Raptis D.A.
        • et al.
        The role of the graft to recipient weight ratio on enhanced recovery of the recipient after living donor liver transplantation - a systematic review of the literature and expert panel recommendations.
        Clin Transpl. 2022; e14630https://doi.org/10.1111/ctr.14630
        • Brige P.
        • Hery G.
        • Chopinet S.
        • Palen A.
        • Azoulay D.
        • Gregoire E.
        Morbidity and mortality of hepatic right lobe living donors: systematic review and perspectives.
        J Gastrointestin Liver Dis. 2018; 27: 169-178https://doi.org/10.15403/jgld.2014.1121.272.mor
        • Hernandez-Alejandro R.
        • Ruffolo L.I.
        • Sasaki K.
        • Tomiyama K.
        • Orloff M.S.
        • Pineda-Solis K.
        • et al.
        Recipient and donor outcomes after living-donor liver transplant for unresectable colorectal liver metastases.
        JAMA Surg. 2022; https://doi.org/10.1001/jamasurg.2022.0300
        • Vargas P.A.
        • McCracken E.K.E.
        • Mallawaarachchi I.
        • Ratcliffe S.J.
        • Argo C.
        • Pelletier S.
        • et al.
        Donor morbidity is equivalent between right and left hepatectomy for living liver donation: a meta-analysis.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2021; https://doi.org/10.1002/lt.26183
        • Yadav S.K.
        • Saraf N.
        • Saigal S.
        • Choudhary N.S.
        • Goja S.
        • Rastogi A.
        • et al.
        High MELD score does not adversely affect outcome of living donor liver transplantation: experience in 1000 recipients.
        Clin Transpl. 2017; 31https://doi.org/10.1111/ctr.13006
        • Selzner M.
        • Kashfi A.
        • Cattral M.S.
        • Selzner N.
        • McGilvray I.D.
        • Greig P.D.
        • et al.
        Live donor liver transplantation in high MELD score recipients.
        Ann Surg. 2010; 251: 153-157https://doi.org/10.1097/SLA.0b013e3181bc9c6a
        • Park S.J.
        • Lim Y.-S.
        • Hwang S.
        • Heo N.Y.
        • Lee H.C.
        • Suh D.J.
        • et al.
        Emergency adult-to-adult living-donor liver transplantation for acute liver failure in a hepatitis B virus endemic area.
        Hepatology. 2010; 51: 903-911https://doi.org/10.1002/hep.23369
        • Wang Y.-C.
        • Yong C.-C.
        • Lin C.-C.
        • Alam H.
        • Naseer F.
        • Lin Y.-H.
        • et al.
        Excellent outcome in living donor liver transplantation treating acute on chronic liver failure patients.
        Liver Transpl Off Publ Am Assoc Study Liver Dis Int Liver Transpl Soc. 2021; https://doi.org/10.1002/lt.26096