Research Paper Volume 15, Issue 17 pp 8594—8612

Availability of living donor optimizes timing of liver transplant in high-risk waitlisted cirrhosis patients

Fakhar Ali Qazi Arisar1,2,8, , Shiyi Chen3, , Catherine Chen1, , Noorulsaba Shaikh1, , Ravikiran Sindhuvalada Karnam1,2, , Wei Xu3,4, , Sumeet K. Asrani5, , Zita Galvin1,2, , Gideon Hirschfield2,6, , Keyur Patel2,6, , Cynthia Tsien1,2, , Nazia Selzner1,2, , Mark Cattral1,7, , Leslie Lilly1,2, , Mamatha Bhat1,2, ,

  • 1 Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2N2, Canada
  • 2 Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario M5G 2N2, Canada
  • 3 Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario M5G 2C1, Canada
  • 4 Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5G 2C1, Canada
  • 5 Division of Hepatology, Department of Medicine, Baylor University Medical Center, Dallas, TX 75246, USA
  • 6 Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2C4, Canada
  • 7 Department of Surgery, University of Toronto, Toronto, Ontario M5G 2N2, Canada
  • 8 National Institute of Liver and GI Diseases, Dow University of Health Sciences, Karachi, Sindh 75330, Pakistan

Received: January 8, 2023       Accepted: July 17, 2023       Published: September 2, 2023
How to Cite

Copyright: © 2023 Arisar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Liver transplant (LT) candidates have become older and frailer, with growing Non-alcoholic steatohepatitis (NASH) and comorbid disease burden in recent years, predisposing them for poor waitlist outcomes. We aimed to evaluate the impact of access to living donor liver transplantation (LDLT) in waitlisted patients at highest risk of dropout. We reviewed all adult patients with decompensated cirrhosis listed for LT from November 2012 to December 2018. Patients with a potential living donor (pLD) available were identified. Survival analyses with Cox Proportional Hazards models and time to LT with Competing risk models were performed followed by prediction model development. Out of 860 patients who met inclusion criteria, 360 (41.8%) had a pLD identified and 496 (57.6%) underwent LT, out of which 170 (34.2%) were LDLT. The benefit of pLD was evident for all, but patients with moderate to severe frailty at listing (interaction p = 0.03), height <160 cm (interaction p = 0.03), and Model for end stage liver disease (MELD)-Na score <20 (interaction p < 0.0001) especially benefited. Our prediction model identified patients at highest risk of dropout while waiting for deceased donor and most benefiting of pLD (time-dependent area under the receiver operating characteristic curve 0.82). Access to LDLT in a transplant program can optimize the timing of transplant for the increasingly older, frail patient population with comorbidities who are at highest risk of dropout.


ALD: Alcoholic liver disease; BMI: Body mass index; CFS: Clinical Frailty Scale; CKD: Chronic kidney disease; DDLT: Deceased donor liver transplant; HCV: Hepatitis C virus; HRS: Hepatorenal syndrome; IHD: Ischemic heart disease; LDLT: Living donor liver transplant; LT: Liver Transplantation; NASH: Non-alcoholic steatohepatitis; pLD: Potential living donor; SBP: Spontaneous bacterial peritonitis; UHN: University Health Network.