Journal article
Variation in adult living donor liver transplantation in the united states: Identifying opportunities for increased utilization
Clinical transplantation, Vol.37(7), e14924
07/2023
DOI: 10.1111/ctr.14924
PMID: 36733213
Abstract
In the United States, living donor liver transplantation (LDLT) is limited to transplant centers with specific experience. However, the impact of recipient characteristics on procedure selection (LDLT vs deceased donor liver transplant [DDLT]) within these centers has not been described. Transplant registry data for centers that performed ≥1 LDLT in 2002-2019 were analyzed using hierarchal regression modeling to quantify the impact of patient and center factors on the adjusted odds ratio (aOR) of LDLT (vs DDLT). Among 73,681 adult recipients, only 4% underwent LDLT, varying from <1% to >60% of total liver transplants. After risk adjustment, the likelihood of receiving an LDLT rose by 73% in recent years (aOR 1.73 for 2014-2019 vs 2002-2007) but remained lower for older adults, men, racial and ethnic minorities and obese patients. LDLT was less commonly used in patients with hepatocellular carcinoma or alcoholic cirrhosis, and more frequently in those with hepatitis C and with lower severity of illness (MELD< 15). Patients with public insurance, lower educational achievement, and residence in the Northwest and Southeast had decreased access. While some differences in access to LDLT reflect clinical factors, further exploration into disparities based on center practice and socioeconomic determinants of health is needed. This article is protected by copyright. All rights reserved.
Details
- Title: Subtitle
- Variation in adult living donor liver transplantation in the united states: Identifying opportunities for increased utilization
- Creators
- Krista L Lentine - Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USATomohiro Tanaka - Organ Transplant Center, University of Iowa, Iowa City, IA, USAHuiling Xiao - Saint Louis UniversityTherese Bittermann - University of PennsylvaniaMary Amanda Dew - University of PittsburghMark A Schnitzler - Saint Louis UniversityKim M Olthoff - University of PennsylvaniaJayme E Locke - University of AlabamaSukru Emre - Ege UniversityHeather F Hunt - United Network for Organ Sharing, Richmond, VA, USAAnnMarie Liapakis - University of New HavenDavid A Axelrod - Organ Transplant Center, University of Iowa, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Clinical transplantation, Vol.37(7), e14924
- DOI
- 10.1111/ctr.14924
- PMID
- 36733213
- NLM abbreviation
- Clin Transplant
- ISSN
- 0902-0063
- eISSN
- 1399-0012
- Grant note
- DOI: 10.13039/100000062, name: National Institute of Diabetes and Digestive and Kidney Diseases, award: R01DK120518
- Language
- English
- Electronic publication date
- 02/02/2023
- Date published
- 07/2023
- Academic Unit
- Gastroenterology and Hepatology; Surgery; Internal Medicine
- Record Identifier
- 9984364515202771
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