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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 4/2024

21-02-2024 | Portal Vein Thrombosis | Original Article

Early Graft Failure After Living-Donor Liver Transplant

Authors: Ahmad Anouti, Moustafa Al Hariri, Lisa B. VanWagner, William M. Lee, Arjmand Mufti, Mark Pedersen, Jigesh Shah, Steven Hanish, Parsia A. Vagefi, Thomas G. Cotter, Madhukar S. Patel

Published in: Digestive Diseases and Sciences | Issue 4/2024

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Abstract

Background

Living-donor liver transplantation (LDLT) has been increasing in the USA. While data exist on longer-term patient and graft outcomes, a contemporary analysis of short-term outcomes is needed.

Aim

Evaluate short-term (30-day) graft failure rates and identify predictors associated with these outcomes.

Methods

Adult (≥ 18) LDLT recipients from 01/2004 to 12/2021 were analyzed from the United States Scientific Registry of Transplant Recipients. Graft status at 30 days was assessed with graft failure defined as retransplantation or death. Comparison of continuous and categorical variables was performed and a multivariable logistic regression was used to identify risk factors of early graft failure.

Results

During the study period, 4544 LDLTs were performed with a graft failure rate of 3.4% (155) at 30 days. Grafts from male donors (aOR: 0.63, CI 0.44–0.89), right lobe grafts (aOR: 0.40, CI 0.27–0.61), recipients aged > 60 years (aOR: 0.52, CI 0.32–0.86), and higher recipient albumin (aOR: 0.73, CI 0.57–0.93) were associated with superior early graft outcomes, whereas Asian recipient race (vs. White; aOR: 3.75, CI 1.98–7.10) and a history of recipient PVT (aOR: 2.7, CI 1.52–4.78) were associated with inferior outcomes. LDLTs performed during the most recent 2016–2021 period (compared to 2004–2009 and 2010–2015) resulted in significantly superior outcomes (aOR: 0.45, p < 0.001).

Conclusion

Our study demonstrates that while short-term adult LDLT graft failure is uncommon, there are opportunities for optimizing outcomes by prioritizing right lobe donation, improving candidate nutritional status, and careful pre-transplant risk assessment of candidates with known PVT. Notably, a period effect exists whereby increased LDLT experience in the most recent era correlated with improved outcomes.

Graphical Abstract

Appendix
Available only for authorised users
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Metadata
Title
Early Graft Failure After Living-Donor Liver Transplant
Authors
Ahmad Anouti
Moustafa Al Hariri
Lisa B. VanWagner
William M. Lee
Arjmand Mufti
Mark Pedersen
Jigesh Shah
Steven Hanish
Parsia A. Vagefi
Thomas G. Cotter
Madhukar S. Patel
Publication date
21-02-2024
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 4/2024
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-024-08280-5

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