Impact of Diverse Clinical Characteristics on Survival Benefit of Liver Transplantation

Liver transplantation (LT) is offered as a life-saving treatment to those with end-stage liver disease. There has recently been much interest in considering the survival benefit of transplant when prioritizing patients for transplant. In this study, we aimed to measure the survival benefit of LT across various patient demographics by measuring the number of life-years gained after LT.

In this study, 101,770 patients were included from the Scientific Registry of Transplant Recipients (SRTR) transplanted between 2003 and 2021. The survival benefit of LT was calculated using restricted mean survival time (RMST) in the next 16 years post-transplant. Cox proportional hazard models and Weibull models were employed to quantify the impact of various predictors on survival benefit.

LT was found to provide survival gains of 4.93, 6.43, 6.30, and 3.67 years for the 18-29, 30-49, 50-69, and 70+ age groups, respectively. Survival benefit was highest at 6.62 years for patients with model for end-stage liver disease (MELD) scores of 15-19, with survival benefits of 5.7, 5.4, and 5.85 years for the 6-14, 20-29, and 30-40 MELD score cohorts, respectively. Older age (HR: 1.13), male sex (HR: 1.32), diabetes (HR: 1.32), and higher MELD scores were predictors of lesser survival benefit. Protective factors included higher education levels (HR: 0.70) as well as diagnoses of fulminant liver failure and autoimmune biliary disease (HR: 0.65).

This study underscores how survival benefit varies across patients with different demographic and clinical characteristics, highlighting the nuanced interplay of these characteristics with survival and emphasizing the need for tailored post-transplant management strategies to optimize outcomes.