Skip to main content
SpringerLink
Log in

Early Graft Failure After Living-Donor Liver Transplant

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The SRTR data system includes data on all donor, wait-listed candidates, and transplant recipients in the USA, submitted by the members of the Organ Procurement and Transplantation Network (OPTN). The Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, provide oversight to the activities of OPTN and SRTR contractors.

References

  1. Gruessner RWG, Gruessner AC. Solid-organ transplants from living donors: cumulative united states experience on 140,156 living donor transplants over 28 years. Transplant Proc. 2018;50:3025–3035.

    Article  CAS  PubMed  Google Scholar 

  2. Cotter TG, Sandıkçı B, Paul S et al. Liver transplantation for alcoholic hepatitis in the United States: excellent outcomes with profound temporal and geographic variation in frequency. Am J Transplant. 2021;21:1039–1055.

    Article  PubMed  Google Scholar 

  3. Lo CM. Expanding living donor liver transplantation. Liver Transpl. 2016;22:37–39.

    Article  PubMed  Google Scholar 

  4. Cotter TG, Paul S, Sandıkçı B et al. Improved graft survival after liver transplantation for recipients with hepatitis C virus in the direct-acting antiviral era. Liver Transpl. 2019;25:598–609.

    Article  PubMed  Google Scholar 

  5. Goldaracena N, Barbas AS. Living donor liver transplantation. Curr Opin Organ Transplant. 2019;24:131–137.

    Article  PubMed  Google Scholar 

  6. OPTN. O.P.a.T.N. OPTN metrics. https://optn.transplant.hrsa.gov/data/visual-dashboards/optn-metrics/. Accessed 9 Nov 2022

  7. Kwong AJ, Ebel NH, Kim WR et al. OPTN/SRTR 2020 annual data report: liver. Am J Transplant. 2022;22:204–309.

    Article  PubMed  Google Scholar 

  8. Cotter TG, Minhem M, Wang J et al. Living donor liver transplantation in the united states: evolution of frequency, outcomes, center volumes, and factors associated with outcomes. Liver Transpl. 2021;27:1019–1031.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Goto T, Ivanics T, Cattral MS et al. Superior long-term outcomes of adult living donor liver transplantation: a cumulative single-center cohort study with 20 years of follow-up. Liver Transpl. 2022;28:834–842.

    Article  PubMed  Google Scholar 

  10. Jackson WE, Malamon JS, Kaplan B et al. Survival benefit of living-donor liver transplant. JAMA Surg. 2022;157:926–932.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Olthoff KM, Smith AR, Abecassis M et al. Defining long-term outcomes with living donor liver transplantation in North America. Ann Surg. 2015;262:465–475 (Discussion 473-465).

    Article  PubMed  Google Scholar 

  12. Kitajima T, Moonka D, Yeddula S et al. Outcomes in living donor compared with deceased donor primary liver transplantation in lower acuity patients with model for end-stage liver disease scores <30. Liver Transpl. 2021;27:971–983.

    Article  PubMed  Google Scholar 

  13. Nakamura T, Nobori S, Harada S et al. Impact of donor and recipient age on outcomes after living donor liver transplant. Transplant Proc. 2022;54:438–442.

    Article  PubMed  Google Scholar 

  14. Nitski O, Azhie A, Qazi-Arisar FA et al. Long-term mortality risk stratification of liver transplant recipients: real-time application of deep learning algorithms on longitudinal data. Lancet Digit Health. 2021;3:e295–e305.

    Article  CAS  PubMed  Google Scholar 

  15. Levitsky J, Goldberg D, Smith AR et al. Acute rejection increases risk of graft failure and death in recent liver transplant recipients. Clin Gastroenterol Hepatol. 2017;15:584-593.e582.

    Article  PubMed  Google Scholar 

  16. Idossa DW, Simonetto DA. Infectious complications and malignancies arising after liver transplantation. Anesthesiol Clin. 2017;35:381–393.

    Article  PubMed  Google Scholar 

  17. Xue Z, Zhang X, Li Z et al. Analysis of portal vein thrombosis after liver transplantation. ANZ J Surg. 2019;89:1075–1079.

    Article  PubMed  Google Scholar 

  18. Duffy JP, Hong JC, Farmer DG et al. Vascular complications of orthotopic liver transplantation: experience in more than 4200 patients. J Am Coll Surg. 2009;208:896–903 (Discussion 903-895).

    Article  PubMed  Google Scholar 

  19. Acuna SA, Zhang W, Yoon PD et al. Right lobe versus left lobe living donor liver transplantation: a systematic review and meta-analysis of donor and recipient outcomes. Transplantation. 2022;106:2370–2378.

    Article  PubMed  Google Scholar 

  20. Sudhindran S, Menon RN, Balakrishnan D. Challenges and outcome of left-lobe liver transplants in adult living donor liver transplants. J Clin Exp Hepatol. 2012;2:181–187.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Herrero JI, Lucena JF, Quiroga J et al. Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy. Am J Transplant. 2003;3:1407–1412.

    Article  PubMed  Google Scholar 

  22. Avanaz A, Doğru V, Kisaoglu A et al. Impact of older age on the long-term survival in living-donor liver transplantation: a propensity score matching analysis. Asian J Surg. 2022;45:2239–2245.

    Article  PubMed  Google Scholar 

  23. Kwon JH, Yoon YI, Song GW et al. Living donor liver transplantation for patients older than age 70 years: a single-center experience. Am J Transplant. 2017;17:2890–2900.

    Article  CAS  PubMed  Google Scholar 

  24. Jalan R, Schnurr K, Mookerjee RP et al. Alterations in the functional capacity of albumin in patients with decompensated cirrhosis is associated with increased mortality. Hepatology. 2009;50:555–564.

    Article  CAS  PubMed  Google Scholar 

  25. Oettl K, Birner-Gruenberger R, Spindelboeck W et al. Oxidative albumin damage in chronic liver failure: relation to albumin binding capacity, liver dysfunction and survival. J Hepatol. 2013;59:978–983.

    Article  CAS  PubMed  Google Scholar 

  26. Domenicali M, Baldassarre M, Giannone FA et al. Posttranscriptional changes of serum albumin: clinical and prognostic significance in hospitalized patients with cirrhosis. Hepatology. 2014;60:1851–1860.

    Article  CAS  PubMed  Google Scholar 

  27. Giannone FA, Domenicali M, Baldassarre M et al. Ischaemia-modified albumin: a marker of bacterial infection in hospitalized patients with cirrhosis. Liver Int. 2015;35:2425–2432.

    Article  CAS  PubMed  Google Scholar 

  28. Baldassarre M, Domenicali M, Naldi M et al. Albumin homodimers in patients with cirrhosis: clinical and prognostic relevance of a novel identified structural alteration of the molecule. Sci Rep. 2016;6:35987.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Alcaraz-Quiles J, Casulleras M, Oettl K et al. Oxidized albumin triggers a cytokine storm in leukocytes through P38 mitogen-activated protein kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology. 2018;68:1937–1952.

    Article  CAS  PubMed  Google Scholar 

  30. Salerno F, Borroni G, Moser P et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993;88:514–519.

    CAS  PubMed  Google Scholar 

  31. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231.

    Article  PubMed  Google Scholar 

  32. Carvalho JR, Verdelho Machado M. New insights about albumin and liver disease. Ann Hepatol. 2018;17:547–560.

    Article  CAS  PubMed  Google Scholar 

  33. Bertelli R, Nardo B, Montalti R et al. Liver transplantation in recipients with portal vein thrombosis: experience of a single transplant center. Transplant Proc. 2005;37:1119–1121.

    Article  CAS  PubMed  Google Scholar 

  34. Park GC, Song GW, Moon DB et al. A review of current status of living donor liver transplantation. Hepatobiliary Surg Nutr. 2016;5:107–117.

    PubMed  PubMed Central  Google Scholar 

  35. Miura K, Sugawara Y, Uchida K et al. Adult living donor liver transplantation for patients with portal vein thrombosis: a single-center experience. Transplant Direct. 2018;4:e341.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ghabril M, Agarwal S, Lacerda M et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation. 2016;100:126–133.

    Article  CAS  PubMed  Google Scholar 

  37. Ozer A, Aktas H, Yilmaz TU et al. Liver transplant in patients with portal vein thrombosis: the experience of 55 patients. Exp Clin Transplant. 2019. https://doi.org/10.6002/ect.2018.0260.

    Article  PubMed  Google Scholar 

  38. Sharma R, Kashyap R, Jain A et al. Surgical complications following liver transplantation in patients with portal vein thrombosis–a single-center perspective. J Gastrointest Surg. 2010;14:520–527.

    Article  PubMed  Google Scholar 

  39. Kadry Z, Selzner N, Handschin A et al. Living donor liver transplantation in patients with portal vein thrombosis: a survey and review of technical issues. Transplantation. 2002;74:696–701.

    Article  PubMed  Google Scholar 

  40. Kwong A, Kim WR, Lake JR et al. OPTN/SRTR 2018 annual data report: liver. Am J Transplant. 2020;20:193–299.

    Article  PubMed  Google Scholar 

  41. Olthoff KM, Merion RM, Ghobrial RM et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg. 2005;242:314–323 (Discussion 323-315).

    Article  PubMed  PubMed Central  Google Scholar 

  42. Marcos A. Right lobe living donor liver transplantation: a review. Liver Transpl. 2000;6:3–20.

    Article  CAS  PubMed  Google Scholar 

  43. Bak T, Wachs M, Trotter J et al. Adult-to-adult living donor liver transplantation using right-lobe grafts: results and lessons learned from a single-center experience. Liver Transpl. 2001;7:680–686.

    Article  CAS  PubMed  Google Scholar 

  44. Lo CM, Fan ST, Liu CL et al. Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg. 2004;240:151–158.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The data reported in this study have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government

Funding

The funding agencies had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA

    Ahmad Anouti, Lisa B. VanWagner, William M. Lee, Arjmand Mufti, Mark Pedersen & Thomas G. Cotter

  2. Qatar University Health Cluster, Qatar University, Doha, Qatar

    Moustafa Al Hariri

  3. Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA

    Jigesh Shah, Steven Hanish, Parsia A. Vagefi & Madhukar S. Patel

Authors
  1. Ahmad Anouti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moustafa Al Hariri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa B. VanWagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William M. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arjmand Mufti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jigesh Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven Hanish
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Parsia A. Vagefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Thomas G. Cotter
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Madhukar S. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Madhukar S. Patel.

Ethics declarations

Conflict of interest

AA, MAH, and CH have no relevant disclosures. Dr. Patel is supported as the Dedman Scholar of Clinical Care at UT Southwestern Medical center. The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript. Dr. Cotter is supported by the American Association for the Study of Liver Diseases (AASLD) Clinical, Translational and Outcomes Research Award (CTORA) and National Institute for Alcohol Abuse and Alcoholism (NIAAA) K23AA031310 grant. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr. Lee is supported by U01 DK58369 and by research support from Intercept, Aurora, Gilead, Novo Nordisk, Alexion, Eiger, Camurus and Lipocine and consults for Forma, SeaGen, GSK, Karuna, and Cortexyme. Dr. VanWagner is supported by NIH grant R56 HL155093 and by research support from W.L. Gore & Associates and the American Society for Transplantation, consults for Gerson Lehrman Group and Numares, and serves as an expert witness.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anouti, A., Al Hariri, M., VanWagner, L.B. et al. Early Graft Failure After Living-Donor Liver Transplant. Dig Dis Sci 69, 1488–1495 (2024). https://doi.org/10.1007/s10620-024-08280-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-024-08280-5

Keywords

Search

Navigation