Background & Aims: Emergency living donor liver transplantation (LDLT) is vital for acute liver failure or acute-on-chronic liver failure patients facing life-threatening scenarios. Our study aimed to assess risk factors influencing the urgency of patients awaiting emergency LDLT and outcomes of emergency LDLT using Korean nationwide data.
Methods: We included patients approved for emergency LDLT between 2017 and 2021. Subgroups included: 1) LDLT recipients (e-LDLT), 2) deceased-donor liver transplant recipients (DDLT; received while waiting), 3) patients who died before receiving LT (death on waiting, DOW), and 4) cases of non-emergency LDLT/ delayed LT >[A4] 14 d after application (UNN). We compared e-LDLT characteristics and survival to non-emergency LDLT controls. Adult DOW and UNN groups were compared to establish risk factors and a scoring system. Baseline characteristics, including changes in the model for end-stage liver disease (ΔMELD) scores, were analyzed.
Results: Adult e-LDLT 3-year survival rates were 78.3% (overall) and 90.1% (graft); Samsung Medical Center LDLT rates were 89.1% (overall) and 93.5% (graft). Chronic kidney disease (CKD), ventilator use, ΔMELD scores, and re-transplantation were associated with worsened adult e-LDLT survival. The leading reasons for emergency LDLT were hepatic encephalopathy, high MELD (>35), and uncontrolled bleeding. When comparing the DOW and UNN groups, hepatitis B virus (HBV), albumin, care in the intensive care unit, ventilator care, and MELD scores influenced patient mortality. A risk scoring system incorporating MELD scores (>30), serum albumin levels (≤2.8 g/dl), ΔMELD scores (>10%), and HBV status was created.
Conclusions: Emergency LDLT showed reasonable survival with CKD, ventilator use, re-LT, and ΔMELD scores as risk factors. High baseline MELD scores, ΔMELD scores, ventilator use, low albumin levels, and HBV relate to pre-LT mortality, reflecting the urgency of LT.