Long-term outcome after living donor liver transplantation compared to

Abstract

Knowledge of living donor liver transplantation (LDLT) for autoimmune liver diseases (AILDs) is scarce. This study analyzed survival in LDLT recipients registered in the European Liver Transplant Registry with autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis (PSC) and the non-autoimmune disorder alcohol-related cirrhosis. In total, 29 902 individuals enrolled between 1998 and 2017 were analyzed, including 1003 with LDLT. Survival from >90 days after LDLT for AILDs in adults was 85.5%, 74.2%, and 58.0% after 5, 10, and 15 years. Adjusted for recipient age, sex, and liver transplantation era, adult PSC patients receiving LDLT showed increased mortality compared to donation after brain death (DBD) (hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.36-2.80, p < .001). Pediatric PSC patients showed also increased mortality >90 days after LDLT compared to DBD (HR = 3.00, 95% CI 1.04-8.70, p = .043). Multivariate analysis identified several risk factors for death in adult PSC patients receiving LDLT including a male donor (HR = 2.49, p = .025). Adult PSC patients with LDLT versus DBD conferred increased mortality from disease recurrence (subdistribution hazard ratio [subHR] = 5.36, p = .001) and biliary complications (subHR = 4.40, p = .006) in multivariate analysis. While long-term outcome following LDLT for AILD is generally favorable, PSC patients with LDLT compared to DBD might be at increased risk of death.

C1 [Heinemann, Melina; Liwinski, Timur; Lohse, Ansgar W.; Schramm, Christoph] Univ Med Ctr Hamburg Eppendorf, Dept Med 1, Hamburg, Germany.

[Liwinski, Timur; Schramm, Christoph; Contributing Centers] European Reference Network Hepatol Dis, Hamburg, Germany.

[Adam, Rene] Univ Paris Sud, Paul Brousse Hosp, AP HP, Hepatobiliary Ctr, Villejuif, France.

[Berenguer, Marina] Univ Valencia, La Fe Univ Hosp, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Liver Transplantat & Hepatol Unit, Valencia, Spain.

[Mirza, Darius] Queen Elizabeth Hosp, Dept HPB Surg, Birmingham, W Midlands, England.

[Malek-Hosseini, Seyed Ali] Shiraz Univ Med Sci, Avicenna Ctr Med & Organ Transplant, Shiraz, Iran.

[Heneghan, Michael A.] Kings Coll Hosp NHS Fdn Trust, Kings Liver Transplant Unit, London, England.

[Lodge, Peter] Leeds Teaching Hosp NHS Trust, Leeds, W Yorkshire, England.

[Pratschke, Johann] Charite Univ Med Berlin, Dept Surg, Campus Charite Mitte, Berlin, Germany.

[Pratschke, Johann] Campus Virchow Klinikum, Berlin, Germany.

[Boudjema, Karim] Pontchaillou Univ Hosp, Dept Hepatobiliary & Digest Surg, Rennes, France.

[Paul, Andreas] Univ Hosp Essen, Dept Visceral & Transplant Surg, Essen, Germany.

[Zieniewicz, Krzysztof] Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland.

[Fronek, Jiri] Inst Clin & Expt Med, Dept Transplant Surg, Prague, Czech Republic.

[Mehrabi, Arianeb] Heidelberg Univ, Dept Gen Visceral & Transplantat Surg, Heidelberg, Germany.

[Acarli, Koray] Mem Hosp, Organ Transplantat Ctr, Istanbul, Turkey.

[Tokat, Yaman] Florence Nightingale Hosp, Liver Transplantat Ctr, Istanbul, Turkey.

[Coker, Ahmet] Ege Univ, Med Sch, Dept Gen Surg, Izmir, Turkey.

[Yilmaz, Sezai] Inonu Univ, Fac Med, Dept Surg, Malatya, Turkey.

[Yilmaz, Sezai] Inonu Univ, Fac Med, Liver Transplant Inst, Malatya, Turkey.

[Duvoux, Christophe] Univ Hosp Henri Mondor, Dept Hepatol & Gastroenterol, Creteil, France.

[Lohse, Ansgar W.; Schramm, Christoph] Univ Med Ctr Hamburg Eppendorf, Martin Zeitz Ctr Rare Dis, Hamburg, Germany.