Risk stratification of emergent living donor liver transplantation from a nationwide survey of the Republic of Korea

초록

Background and aims: Emergent living donor liver transplantation (LDLT) is vital for acute liver failure or acute-on-chronic liver failure patients facing life-threatening scenarios. Our study aimed to assess risk factors influencing the emergency of patients awaiting LDLT and outcomes of emergent LDLT using Korean nationwide data. Method: We included patients who applied for emergency LDLT between 2017 and 2021. Subgroups included: 1) LDLT recipients (eLDLT), 2) deceased donor liver transplant recipients (DDLT; received while waiting), 3) patients who died before receiving LT (death on waiting, DOW), and 4) patients of who recovered without LT or delayed LT >14 d after application (emergent LDLT unnecessary group, UNN). We compared e-LDLT characteristics and survival between eLDLT and non-emergency LDLT controls. DOW and UNN groups were compared to establish risk factors and a scoring system. Baseline characteristics, including changes in model for end-stage liver disease (ΔMELD) scores, were analyzed. Results: Among a total of 594 applicants for emergent LDLT, the number of e-LDLT, DDLT, DOW, and UNN groups was 419, 71, 43, and 37, respectively. Adult e-LDLT 3-year survival rates were 78·3% (overall) and 90·1% (graft); 3-year survival rates of adult nonemergent LDLT patients were 89·1% (overall) and 93·7% (graft). Chronic kidney disease, ventilator use, ΔMELD scores, and retransplantation were associated with worsened adult e-LDLT survival. Leading reasons for emergency LDLT were hepatic encephalopathy, high MELD (>35), and uncontrolled bleeding. When comparing the adult DOW and adult UNN groups, hepatitis B virus (HBV), albumin, care in intensive care unit, ventilator use, and MELD score influenced patient mortality in univariable analysis. Conclusion: Emergent LDLT showed reasonable survival with CKD, ventilator use, re-LT, and ΔMELD score as risk factors. High baseline MELD score, ΔMELD score, ventilator use, low albumin levels, and HBV relate to pre-LT mortality, reflecting the emergency of LT.