Early Graft Failure After Living-Donor Liver Transplant

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: (Figure presented.).