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Master of Public Health

Trends and Healthcare Outcomes among Live Liver Donors- Are we ready to expand the donor pool with Live Liver Donations?

AUTHORS

Jalil S , Black SM , Washburn K , Rangwani N , Hinton A , Kelly SG , Conteh L , Hanje J , Michaels A , Mumtaz K , . Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2021 7 2; ().

ABSTRACT

OBJECTIVES: We studied the trends and various outcomes, including the readmission rates, healthcare utilization, and complications among live liver donors (LLD) in the US.

METHODS: We queried the National Database from 2010 to 2017 for all LLDs. The primary outcomes were 30- and 90-day readmission rates. The secondary outcomes included healthcare utilization [length of stay (LOS), cost of care], index admission and calendar year mortality. Logistic regression models were fit for various outcomes.

RESULTS: A total of 1,316 LLDs underwent hepatectomy during the study period. The median donor age was 35.0(IQR: 27.4-43.6), predominantly females (54.2%). Trend of LLDs surgeries remained stable at large medical centers (85.3%). 30-day and 90-day readmission rates were low at 5% and 5.9%, respectively. Older age (50+) (8%; CI: 0.6%-15.9%, p-value: 0.03) and hepatectomy at small to medium-size hospitals were associated with increased index LOS (13.4%; CI: 3.1%-24.7%, p=0.01). Moreover, older age of donor (-11.3%;CI: -20.3% to -1.4%,p-value=0.03), Elixhauser score ≥3 (17%;CI:1.2%-35.3%,p=0.03) and Medicaid insurance (24.5%;CI:1.2%-53.1%,p-value=0.04) were also associated with increased cost. The overall rate of any complications during index admission was 42.8%. Male gender (OR: 1.63; CI: 1.19-2.23) was an independent predictor of post-LLD complications. There was no index admission or calendar year mortality reported during the study period.

CONCLUSIONS: This is the largest national report of LLDs to date, showing that trend of LLD is stable in the US. With established safety, fewer complications and low healthcare utilization, LLD can be a potential source of continuation of liver transplant, in the context of changing liver allocation policies in the United States.

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