Optimal Timing for Liver Transplant in High-Risk Cirrhosis Patients | Aging-US



September 25, 2023

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  • Aging-US published this research paper on September 2, 2023 in Volume 15, Issue 17, entitled, “Availability of living donor optimizes timing of liver transplant in high-risk waitlisted cirrhosis patients" by researchers from Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2N2, Canada; Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario M5G 2N2, Canada; Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario M5G 2C1, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5G 2C1, Canada; Division of Hepatology, Department of Medicine, Baylor University Medical Center, Dallas, TX; Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario M5G 2C4, Canada; Department of Surgery, University of Toronto, Toronto, Ontario M5G 2N2, Canada; National Institute of Liver and GI Diseases, Dow University of Health Sciences, Karachi, Sindh 75330, Pakistan. DOI - https://doi.org/10.18632/aging.204982 Corresponding author - Mamatha Bhat - mamatha.bhat@uhn.ca Abstract 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. Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.204982 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, living donor liver transplant, frailty, old age, short-statured, MELD score, prediction model About Aging-US Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at https://www.Aging-US.com​​ and connect with us: SoundCloud - https://soundcloud.com/Aging-Us Facebook - https://www.facebook.com/AgingUS/ Twitter - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Media Contact 18009220957 MEDIA@IMPACTJOURNALS.COM

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