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Defining long-term outcomes with living donor liver transplantation in North America.

Publication ,  Conference
Olthoff, KM; Smith, AR; Abecassis, M; Baker, T; Emond, JC; Berg, CL; Beil, CA; Burton, JR; Fisher, RA; Freise, CE; Gillespie, BW; Grant, DR ...
Published in: Ann Surg
September 2015

OBJECTIVES: To compare long-term survival of living donor liver transplant (LDLT) at experienced transplant centers with outcomes of deceased donor liver transplant and identify key variables impacting patient and graft survival. BACKGROUND: The Adult-to-Adult Living Donor Liver Transplantation Cohort Study is a prospective multicenter National Institutes of Health study comparing outcomes of LDLT and deceased donor liver transplant and associated risks. METHODS: Mortality and graft failure for 1427 liver recipients (963 LDLT) enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study who received transplant between January 1, 1998, and January 31, 2014, at 12 North American centers with median follow-up 6.7 years were analyzed using Kaplan-Meier and multivariable Cox models. RESULTS: Survival probability at 10 years was 70% for LDLT and 64% for deceased donor liver transplant. Unadjusted survival was higher with LDLT (hazard ratio = 0.76, P = 0.02) but attenuated after adjustment (hazard ratio = 0.98, P = 0.90) as LDLT recipients had lower mean model for end-stage liver disease (15.5 vs 20.4) and fewer received transplant from intensive care unit, were inpatient, on dialysis, were ventilated, or with ascites. Posttransplant intensive care unit days were less for LDLT recipients. For all recipients, female sex and primary sclerosing cholangitis were associated with improved survival, whereas dialysis and older recipient/donor age were associated with worse survival. Higher model for end-stage liver disease score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT. CONCLUSIONS: LDLT provides significant long-term transplant benefit, resulting in transplantation at a lower model for end-stage liver disease score, decreased death on waitlist, and excellent posttransplant outcomes. Recipient diagnosis, disease severity, renal failure, and ages of recipient and donor should be considered in decision making regarding timing of transplant and donor options.Clinical Trials ID: NCT00096733.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

September 2015

Volume

262

Issue

3

Start / End Page

465 / 475

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Proportional Hazards Models
  • Predictive Value of Tests
  • North America
 

Citation

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ICMJE
MLA
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Olthoff, K. M., Smith, A. R., Abecassis, M., Baker, T., Emond, J. C., Berg, C. L., … Shaked, A. (2015). Defining long-term outcomes with living donor liver transplantation in North America. In Ann Surg (Vol. 262, pp. 465–475). United States. https://doi.org/10.1097/SLA.0000000000001383
Olthoff, Kim M., Abigail R. Smith, Michael Abecassis, Talia Baker, Jean C. Emond, Carl L. Berg, Charlotte A. Beil, et al. “Defining long-term outcomes with living donor liver transplantation in North America.” In Ann Surg, 262:465–75, 2015. https://doi.org/10.1097/SLA.0000000000001383.
Olthoff KM, Smith AR, Abecassis M, Baker T, Emond JC, Berg CL, et al. Defining long-term outcomes with living donor liver transplantation in North America. In: Ann Surg. 2015. p. 465–75.
Olthoff, Kim M., et al. “Defining long-term outcomes with living donor liver transplantation in North America.Ann Surg, vol. 262, no. 3, 2015, pp. 465–75. Pubmed, doi:10.1097/SLA.0000000000001383.
Olthoff KM, Smith AR, Abecassis M, Baker T, Emond JC, Berg CL, Beil CA, Burton JR, Fisher RA, Freise CE, Gillespie BW, Grant DR, Humar A, Kam I, Merion RM, Pomfret EA, Samstein B, Shaked A. Defining long-term outcomes with living donor liver transplantation in North America. Ann Surg. 2015. p. 465–475.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

September 2015

Volume

262

Issue

3

Start / End Page

465 / 475

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Time Factors
  • Survival Analysis
  • Surgery
  • Risk Assessment
  • Retrospective Studies
  • Proportional Hazards Models
  • Predictive Value of Tests
  • North America