Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplantation. Sep 10, 2018; 8(5): 167-177
Published online Sep 10, 2018. doi: 10.5500/wjt.v8.i5.167
Trends of characteristics and outcomes of donors and recipients of deceased donor liver transplantation in the United States: 1990 to 2013
Subhashini Ayloo, Sri Ram Pentakota, Michele Molinari
Subhashini Ayloo, Sri Ram Pentakota, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Michele Molinari, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Author contributions: Ayloo S contributed to this paper with conception, design, analysis, and manuscript drafting; Pentakota SR contributed to data analysis; Molinari M contributed to data analysis and manuscript drafting.
Institutional review board statement: The study did not require approval by the ethics review board of our institution because it was conducted and reported per STROBE statement recommendations which was acknowledged in the methods section of the manuscript. This data is available to everybody and is provided by OPTN/UNOS as SRTR files.
Informed consent statement: Not applicable.
Conflict-of-interest statement: All authors report no conflict of interest.
STROBE statement: The study was reported in accordance with STROBE statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Subhashini Ayloo, MD, Associate Professor, Senior Scientist, Statistician, Surgeon, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB G586, Newark, NJ 07103, United States. ayloo.sub@rutgers.edu
Telephone: +1-973-9725874 Fax: +1-973-9723135
Received: April 6, 2018
Peer-review started: April 7, 2018
First decision: May 16, 2018
Revised: July 23, 2018
Accepted: August 3, 2018
Article in press: August 4, 2018
Published online: September 10, 2018
Abstract
AIM

To compare trends in donor/recipient characteristics and outcomes using four period cohorts of liver transplant recipients from 1990 to 2009.

METHODS

Seventy thousand three hundred and seventy-seven adult first-time recipients of whole-organ deceased-donor liver grafts from 1990 to 2009 were followed up until September 2013. Four periods based on transplantation dates were considered to account for developments in transplantation. Descriptive statistics were used to describe donor/recipient characteristics and transplant outcomes. Statistical comparisons between periods were performed using χ2/Fischer’s exact test (categorical variables) and t-tests/Mann-Whitney U test (continuous variables). Univariate descriptive statistics/survival data were generated using Kaplan-Meier curves. Cox Proportional Hazards models were used for regression analyses of patient and graft survival.

RESULTS

Mean age (years), body mass index (kg/m2), and the proportion of males were, respectively, 39.1 (± 17.4), 25.9 (± 5.7) and 60.3 for donors, and 51.3 (± 10.5), 27.7 (± 5.6), and 64.4 for recipients. Donor and transplantation rates differed between racial/ethnic groups. Median (Q1-Q3) cold and warm ischemia, waitlist, and hospital stay times were 8 (6.0-10.0) h and 45 (35-59) min, 93 (21-278) d, and 12 (8-20) d. Total functional assistance was required by 8% of recipients at wait-listing and 13.4% at transplantation. Overall survival at 1, 3, 5, 10, 15, and 20 years was 87.3%, 79.4%, 73.6%, 59.8%, 46.7%, and 35.9%, respectively. The 2005-2009 cohort had better patient and graft survival than the 1990-1994 cohort overall [HR 0.67 (0.62-0.72) and 0.66 (0.62-0.71)] and at five years [HR 0.73 (0.66-0.80) and 0.71 (0.65-0.77)].

CONCLUSION

Despite changes in donor quality, recipient characteristics, and declining functional status among transplant recipients, overall patient survival is superior and post-transplant outcomes continue to improve.

Keywords: UNOS database, OPTN database, Liver transplant surveillance, Liver transplant outcomes, Liver transplant survival

Core tip: The objective of this study was to compare trends in liver transplant donor/recipient characteristics and outcomes using four period cohorts of adult, first-time whole-organ deceased donor recipients from 1990-2009 using historical data from the OPTN/UNOS database. The landscape of donors and recipients undergoing liver transplantation (LT) in the United States has changed. Donor age, body mass index, and the contribution of racial minorities have increased. Transplant recipients are older, more deconditioned and obese, and with changing causes of cirrhosis. Despite this, the long-term patient survival has improved over time. This paper provides an overview of the landscape of LT in the United States.