Liver Transpl. 2021 Jun 5. doi: 10.1002/lt.26195. Online ahead of print.
ABSTRACT
BACKGROUND: Organ allocation in liver transplantation (LT) remains imperfect. Periodic centre reviews ensure programs transparently evaluate the impact of practice on access to transplantation, reflecting in particular patient (primary disease, social) and program (deceased vs live donation) factors.
METHODS: Adult Ontario residents listed for first liver transplantation at Toronto General Hospital from November 2012 to May 2019 were reviewed. Analyses were performed between distance-to-transplant-centre, income, education level, population density and primary liver disease with LT, deceased donor liver transplant (DDLT), living donor liver transplant (LDLT), and delisting.
RESULTS: Of 1735 listed patients, n=549 were delisted (32%), while n=1071 were transplanted (62%), with 819 DDLT recipients (77%) and 252 LDLT recipients (24%). On univariate analysis, DDLT recipients lived 30% closer (median 39.7 vs. 60.6 km, p<0.001), lived in more populous areas (median 8501.0 vs. 6868.5 people in 1 km radius, p<0.001), and resided in households that earned 10% less (median $92,643.17 vs. $102,820.89 Canadian dollars, p<0.001) compared to LDLT recipients. These findings with population density and income differences between DDLT vs. LDLT receival remained significant on multivariate modelling even when accounting for primary liver disease. Primary liver disease was a statistically significant factor on multivariate analyses in LT receival (p=0.001) as well as DDLT vs. LDLT receival (p<0.001). Of patients listed for end-stage liver disease, more patients with autoimmune cholestatic liver diseases received LDLT (34-41%) than DDLT (27-30%); this contrasted patients with non-cholestatic diseases LDLT (8-19%) vs. DDLT (37-59%) receival (p<0.001).
CONCLUSION: Review of transplant allocation in a large mixed-donor North American liver transplant program demonstrates how patient social determinants and primary disease etiology continue to significantly associate with ultimate transplantation.
PMID:34092028 | DOI:10.1002/lt.26195
