Outcomes of highly urgent living donor liver transplantation in Korean national data
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background: Highly urgent living donor liver transplantation (HU-LDLT) is vital for treating acute liver failure (ALF), acute-on-chronic liver failure (ACLF), and critically ill cirrhotic patients in life-threatening scenarios. The purpose of our study was to identify the characteristics of HU-LDLT patients, compare the outcomes of HU-LDLT patients with those of elective LDLT patients, and determine the risk factors that can influence the outcomes of HU-LDLT. Methods: We retrospectively analyzed Korean Network for Organ Sharing (KONOS) data for consecutive HU-LDLT patients between 2017 and 2021. For comparison with the HU-LDLT group, patients who received elective LDLT except HU-LDLT at Samsung Medical Center during the same period were analyzed as the control group. Results: The most common reasons for HU-LDLT were hepatic encephalopathy, a model for end-stage liver disease (MELD) score ≥35, and uncontrolled varix bleeding. Among the 419 HU-LDLT patients, 53 (12.6%) were pediatric. The cumulative 1-, 3-, and 5-year overall survival rates were 82.4%, 78.3%, and 74.8%, respectively, in the adult HU-LDLT group. The 1-year overall survival rate was 86.1% in the pediatric HU-LDLT group. The presence of chronic kidney disease, pre-transplant ventilator care, high pre-transplant MELD score, and re-transplantation were closely related to mortality in the adult group. Only hepatorenal syndrome (HRS) was a strong risk factor for graft failure in the adult group. The graft and overall survival in the adult HU-LDLT group were significantly lower than those in the control group. Conclusions: High MELD scores, hepatic encephalopathy, and bleeding are the main reasons for HU-LDLT applications in Korea. Graft and overall survival curves in the HU-LDLT group are lower than in the elective LDLT group, but the HU-LDLT outcomes are considered acceptable.
DOI: 10.21037/hbsn-24-300
Institutions: Ministry of Health and Welfare, Korea University, Korea University Medical Center, Korea University Ansan Hospital, Samsung Medical Center, Research Institute for Future Medicine, Sungkyunkwan University, Seoul National University, Ewha Womans University, Ewha Womans University Medical Center, Yonsei University, Yonsei University Health System, Daegu Catholic University, Daegu Catholic University Medical Center, Asan Medical Center, University of Ulsan
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4405763270