Korean J Transplant.  2020 Mar;34(1):47-54. 10.4285/kjt.2020.34.1.47.

Changes in the indications for living donor liver transplantation: single-institution experience of 3,145 cases over 10 years

• Kang SH
• Hwang S
• Ahn CS
• Kim KH
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Namgoong JM
• Yoon YI
• Cho HD
• Kwon JH
• Chung YK
• Choi JU
• Lee SG

• KMID: 2503782
• DOI: http://doi.org/10.4285/kjt.2020.34.1.47

Abstract

Background
To understand the changing demands and recent trends in the indications for living donor liver transplantation (LDLT), the present study aimed to analyze the indications for LDLT performed in a high-volume transplantation center over 10 years.
Methods
The liver transplantation database at our institution was searched to identify patients who underwent LDLT during a 10-year period from January 2008 to December 2017. The study subjects (n=3,145) were divided into two groups: adult patients (n=3,019, 92.7%) and pediatric patients (n=126, 3.9%).
Results
In the adult recipients, the primary diagnoses were hepatitis B virus (HBV)- associated liver cirrhosis (n=1,898, 62.9%), alcoholic liver disease (n=482, 16.0%), hepatitis C virus-associated cirrhosis (n=203, 6.7%), acute liver failure (n=127, n=4.2%), and other diseases (n=157, 5.2%). The mean Model for End-Stage Liver Disease score was 15.6±8.8 (range, 6–40). The proportion of patients with HBV-associated liver disease gradually decreased, but the proportion of those with alcoholic liver disease increased. Hepatocellular carcinoma (HCC) was diagnosed in 1,467 patients (48.6%). The mean proportion of patients with HCC was 63.1% among those with HBVassociated liver disease. In pediatric recipients, the primary diagnoses were biliary atresia (n=51, 40.5%), liver failure of various causes (n=37, 29.4%), metabolic disease (n=22, 17.5%), hepatoblastoma (n=12, 9.5%), and infectious diseases (n=4, 3.2%).
Conclusions
Our results showed that there were some significant changes in the indications of LDLT. We believe that our results may reflect the real changes in the indications of LDLT and they will be useful for predicting further changes in the future.

Keyword

Living donor liver transplantation; Hepatitis B virus; Liver cirrhosis; Pediatric transplantation; Biliary atresia

Figure

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  Fig. 1 Cumulative incidences of annual case numbers in adult patients according to the six categories. HBV, hepatitis B virus-associated liver disease; HCV, hepatitis C virus-associated liver disease; ALD, alcoholic liver disease; CLC, cryptogenic liver cirrhosis; ALF, acute liver failure.

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  Fig. 2 Changes in the proportions of annual cases per disease category in adult patients. HBV, hepatitis B virus-associated liver disease; HCV, hepatitis C virus-associated liver disease; ALD, alcoholic liver disease; CLC, cryptogenic liver cirrhosis; ALF, acute liver failure.

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  Fig. 3 Changes in the number of individual annual cases per disease category in adult patients. HBV, hepatitis B virus; HCV, hepatitis C virus; ALD, alcoholic liver disease; CLC, cryptogenic liver cirrhosis; ALF, acute liver failure.

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  Fig. 4 Changes in the annual proportions of adult patients with hepatocellular carcinoma (HCC).

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  Fig. 5 Changes in the annual proportions of adult patients with hepatocellular carcinoma per disease category. HBV, hepatitis B virus; HCV, hepatitis C virus; ALD, alcoholic liver disease; CLC, cryptogenic liver cirrhosis; ALF, acute liver failure.

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  Fig. 6 Changes in the annual proportions of adult patients with hepatocellular carcinoma (HCC) among those with hepatitis B virus-associated liver disease.

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  Fig. 7 Cumulative incidences of annual case numbers among pediatric patients according to the five categories. BA, biliary atresia; Metabol, metabolic disease; LF, liver failure; Hepatobl, hepatoblastoma; Infection, infectious disease.

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