• Zhihao Li, Owen Jones, Christian T J Magyar, Marco P A W Claasen, Tommy Ivanics, Woo Jin Choi, Luckshi Rajendran, Erin Winter, Roxana Bucur, Nadia Rukavina, Elmar Jaeckel, Nazia Selzner, Blayne A Sayed, Anand Ghanekar, Mark Cattral, and Gonzalo Sapisochin.
• HBP & Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
• Ann. Surg. 2024 Jul 23.

ObjectiveAssess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis.BackgroundLiving-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11.MethodsLiver transplant candidates listed at the Ajmera Transplant Centre (2000-2021) were categorized as pLDLT (having a potential living donor) or pDDLT (without a living donor). Employing Cox proportional-hazard regression with time-dependent covariates, we evaluated pLDLT's impact on waitlist dropout and overall survival through a risk-adjusted analysis.ResultsOf 4,124 candidates, 984 (24%) had potential living donors. The pLDLT group experienced significantly lower overall waitlist dropouts (5.2%vs. 34.4%, P<0.001) and mortality (3.8%vs. 24.4%, P<0.001) compared to the pDDLT group. Possessing a living donor correlated with a 26% decline in the risk of waitlist dropout (adjusted hazard ratio 0.74, 95%CI 0.55-0.99, P=0.042). The pLDLT group also demonstrated superior survival outcomes at 1- (84.9%vs. 80.1%), 5- (77.6%vs. 61.7%), and 10-year (65.6%vs.52.9%) from listing (log-rank P<0.001) with a 35% reduced risk of death (adjusted hazard ratio 0.65, 95%CI 0.56-0.76, P<0.001). Moreover, the predicted hazard ratios consistently remained below 1 across the MELD-Na range 11-26.ConclusionsHaving a potential living donor significantly improves survival in end-stage liver disease patients, even with MELD-Na scores as low as 11. This emphasizes the need to promote awareness and adoption of LDLT in liver transplant programs worldwide.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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