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Defining 10 Year Outcomes with Living Donor Liver Transplantation in North America
Kim M Olthoff1, Abby Smith*2, Michael Abecassis3, Talia Baker*3, Carl Berg*4, Charlotte Beil*2, Jean Emond5, Gregory Everson*6, Chris Freise7, Brenda Gillespie*2, Benjamin Samstein*5, Abraham Shaked1
1University of Pennsylvania, Philadelphia, PA;2Arbor Research, Ann Arbor, MI;3Northwestern University, Chicago, IL;4Duke University, Durham, NC;5Columbia University, New York, NY;6University of Colorado, Denver, CO;7University of California San Francisco, San Francisco, CA

Objectives: Living donor liver transplantation (LDLT) provides an important surgical option for end-stage liver disease. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL), the first multicenter prospective NIH study for LDLT, compared survival benefit between LDLT and deceased donor liver transplant (DDLT) at experienced transplant centers. Post-transplant outcomes up to 10 years were compared and key variables impacting survival identified.
Methods: Outcomes of 1428 liver recipients (964 LDLT) enrolled in A2ALL transplanted between 1/1/1998 and 1/31/2014 at 12 North American centers with median follow-up 4.8 years were analyzed. Kaplan-Meier and multivariable Cox models of time from transplant to death or graft failure were performed.
Results: LDLT recipients had higher prevalence of white race, less HCV/HCC, lower mean MELD (15.4 vs 20.4), and fewer were transplanted from ICU, inpatient, on dialysis, ventilated, or with ascites. Post-transplant ICU days were less for LDLT. Patient 10-yr survival was 70% (LDLT) and 66% (DDLT). Unadjusted survival was higher with LDLT (P=0.05) but attenuated after adjustment (P=0.69). For all recipients, female gender and PSC were associated with improved survival. Factors associated with worse survival were dialysis, and older recipient/donor age. Era of transplantation and type of donated lobe did not significantly impact survival.
Summary: Both LDLT and DDLT provide outstanding long-term survival. LDLT provides significant benefit resulting in transplantation at a lower MELD score, decreased death on waitlist, and excellent post-transplant outcomes. Recipient diagnosis, renal failure and ages of recipient and donor should be considered in decision-making regarding timing of transplant and donor options.


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