title: Defining long-term outcomes with living donor liver transplantation in North America.
abstract: OBJECTIVE
  To compare long-term survival of living donor liver transplant (LDLT) at experienced transplant centers with outcomes of deceased donor liver transplant and identify key variables impacting patient and graft survival.
  
  
  BACKGROUND
  The Adult-to-Adult Living Donor Liver Transplantation Cohort Study is a prospective multicenter National Institutes of Health study comparing outcomes of LDLT and deceased donor liver transplant and associated risks.
  
  
  METHODS
  Mortality and graft failure for 1427 liver recipients (963 LDLT) enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study who received transplant between January 1, 1998, and January 31, 2014, at 12 North American centers with median follow-up 6.7 years were analyzed using Kaplan-Meier and multivariable Cox models.
  
  
  RESULTS
  Survival probability at 10 years was 70% for LDLT and 64% for deceased donor liver transplant. Unadjusted survival was higher with LDLT (hazard ratio = 0.76, P = 0.02) but attenuated after adjustment (hazard ratio = 0.98, P = 0.90) as LDLT recipients had lower mean model for end-stage liver disease (15.5 vs 20.4) and fewer received transplant from intensive care unit, were inpatient, on dialysis, were ventilated, or with ascites. Posttransplant intensive care unit days were less for LDLT recipients. For all recipients, female sex and primary sclerosing cholangitis were associated with improved survival, whereas dialysis and older recipient/donor age were associated with worse survival. Higher model for end-stage liver disease score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT.
  
  
  CONCLUSIONS
  LDLT provides significant long-term transplant benefit, resulting in transplantation at a lower model for end-stage liver disease score, decreased death on waitlist, and excellent posttransplant outcomes. Recipient diagnosis, disease severity, renal failure, and ages of recipient and donor should be considered in decision making regarding timing of transplant and donor options.Clinical Trials ID: NCT00096733.
authors.affiliation: *Department of Surgery, University of Pennsylvania, Philadelphia, PA †Department of Biostatistics, University of Michigan, Ann Arbor, MI ‡Arbor Research Collaborative for Health, Ann Arbor, MI §Northwestern University Comprehensive Transplant Center, Chicago, IL ¶Center for Liver Disease and Transplantation, Columbia University, New York, NY ∥Duke University Health System, Durham, NC **Department of Medicine, University of Colorado, Aurora, CO ††Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA ‡‡Department of Surgery, University of California San Francisco, San Francisco, CA §§Department of General Surgery, Toronto Hospital, General Division, Toronto, Ontario, Canada ¶¶Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA ∥∥Department of Surgery, University of Colorado, Denver, CO ***Department of Surgery, University of Michigan, Ann Arbor, MI; and †††Department of Transplantation, Lahey Clinic Medical Center, Tufts University School of Medicine, Boston, MA.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: Abigail R
authors.initials: AR
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
authors.forename: Carl L
authors.initials: CL
authors.lastname: Berg
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Beil
authors.forename: James R
authors.initials: JR
authors.lastname: Burton
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Chris E
authors.initials: CE
authors.lastname: Freise
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: Igal
authors.initials: I
authors.lastname: Kam
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pomfret
authors.forename: Benjamin
authors.initials: B
authors.lastname: Samstein
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult