Skip to main content
Journal cover image

The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis.

Publication ,  Journal Article
Leung, KK; Kim, A; Hansen, BE; Lilly, L; Selzner, N; Patel, K; Bhat, M; Hirschfield, GM; Galvin, Z
Published in: Liver Transpl
December 2021

Organ allocation in liver transplantation (LT) remains imperfect. Periodic center reviews ensure programs transparently evaluate the impact of practice on access to transplantation, reflecting, in particular, patient (primary disease, social determinants) and program (deceased versus live donation) factors. Adult Ontario residents waitlisted for first LT at Toronto General Hospital from November 2012 to May 2019 were reviewed. Analyses were performed between distance to transplant center, income, education level, population density and primary liver disease, with LT, deceased donor liver transplant (DDLT), living donor liver transplant (LDLT), and delisting. Of 1735 listed patients, 549 were delisted (32%), while 1071 were transplanted (62%), with 819 DDLT recipients (76%) and 252 LDLT recipients (24%), while 115 (7%) remained actively listed at data census. On univariate analysis, DDLT recipients lived 30% closer (median 39.7 versus 60.6 km; P < 0.001), lived in more populous areas (median 8501.0 versus 6868.5 people in a 1-km radius; P < 0.001), and resided in households that annually earned 10% less (median $92,643.17 versus $102,820.89 Canadian dollars; P < 0.001) compared with LDLT recipients. These findings with population density and income differences between DDLT versus LDLT receival remained significant on multivariate modeling even when accounting for primary liver disease. Primary liver disease was a statistically significant factor on multivariate analyses in LT receival (P = 0.001) as well as DDLT versus LDLT receival (P < 0.001). Of patients listed for end-stage liver disease, more patients with autoimmune cholestatic liver diseases received LDLT (34%-41%) than DDLT (27%-30%); this contrasted with patients with noncholestatic diseases LDLT (8%-19%) versus DDLT (37%-59%) receival (P < 0.001). Review of transplant allocation in a large mixed-donor North American liver transplant program demonstrates how patient social determinants and primary liver disease etiology continue to be significantly associated with ultimate transplantation.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Liver Transpl

DOI

EISSN

1527-6473

Publication Date

December 2021

Volume

27

Issue

12

Start / End Page

1733 / 1746

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Social Determinants of Health
  • Retrospective Studies
  • Ontario
  • Living Donors
  • Liver Transplantation
  • Liver Diseases
  • Humans
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Leung, K. K., Kim, A., Hansen, B. E., Lilly, L., Selzner, N., Patel, K., … Galvin, Z. (2021). The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis. Liver Transpl, 27(12), 1733–1746. https://doi.org/10.1002/lt.26195
Leung, Kristel K., Audrey Kim, Bettina E. Hansen, Les Lilly, Nazia Selzner, Keyur Patel, Mamatha Bhat, Gideon M. Hirschfield, and Zita Galvin. “The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis.Liver Transpl 27, no. 12 (December 2021): 1733–46. https://doi.org/10.1002/lt.26195.
Leung KK, Kim A, Hansen BE, Lilly L, Selzner N, Patel K, et al. The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis. Liver Transpl. 2021 Dec;27(12):1733–46.
Leung, Kristel K., et al. “The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis.Liver Transpl, vol. 27, no. 12, Dec. 2021, pp. 1733–46. Pubmed, doi:10.1002/lt.26195.
Leung KK, Kim A, Hansen BE, Lilly L, Selzner N, Patel K, Bhat M, Hirschfield GM, Galvin Z. The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis. Liver Transpl. 2021 Dec;27(12):1733–1746.
Journal cover image

Published In

Liver Transpl

DOI

EISSN

1527-6473

Publication Date

December 2021

Volume

27

Issue

12

Start / End Page

1733 / 1746

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Social Determinants of Health
  • Retrospective Studies
  • Ontario
  • Living Donors
  • Liver Transplantation
  • Liver Diseases
  • Humans
  • Adult