Outcomes of highly urgent living donor liver transplantation in Korean national data

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.