Impact Of Graft Type on Outcomes Following Liver Transplantation for Primary Sclerosing Cholangitis

Impact Of Graft Type on Outcomes Following Liver Transplantation for Primary Sclerosing Cholangitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact Of Graft Type on Outcomes Following Liver Transplantation for Primary Sclerosing Cholangitis Shiva Kumar, Songhua Lin, Jesse D Schold This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4780596/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Oct, 2024 Read the published version in Hepatology International → Version 1 posted 5 You are reading this latest preprint version Abstract Background Limited data exists regarding impact of graft type on outcomes following liver transplantation (LT) in Primary Sclerosing Cholangitis (PSC). Our goal was to evaluate the impact of graft type on outcomes following LT in PSC and determine predictors of outcomes. Methods Using SRTR, retrospective cohorts were constructed over the time period 2010-2020, divided into 2 eras: 2010–2014, 2015–2020, stratified by graft type: living donor (LDLT), donation after circulatory death (DCD) and donation after brain death (DBD). Outcome measures were graft and patient survival. Survival comparison was performed using Kaplan-Meier method and multivariable analysis using Cox proportional hazard models. Results 2966 recipients underwent LT for PSC over the study period: LDLT-PSC 153 (5.2%), DCD-PSC 131 (4.4%) and DBD-PSC 2682 (90.4%). While LDLT utilization was higher in PSC (5.2% vs. 1.3%; p<0.001), DCD use was lower (4.4% vs. 7.2%; p<0.001) but increased over time (era 1 vs. 2: 3.3% vs. 5.2%; p= 0.02). Outcomes following DCD-PSC are comparable to DBD and have improved over time. Compared to DBD-PSC, there was a trend toward lower short-term graft survival following LDLT-PSC (1 Yr. 85.3 vs. 91.9; p=0.07) with higher retransplant rate (LDLT-PSC vs. DCD-PSC vs. DBD-PSC: 15% vs 11% vs 7%; p<0.001). Compared to non-PSC, long-term patient survival was superior in LDLT-PSC (5 Yr. 90.1 vs. 83.7%; p=0.05) and DCD-PSC (93.3 vs. 79.7%, p=0.01). On multivariable analysis, LDLT but not DCD, was associated with inferior graft survival in PSC (adjusted hazard Ratio=1.65 (1.16–2.34); p=0.005). Conclusions In PSC, utilization of LDLT is higher, while DCD use is lower but increased over time. Outcomes following DCD LT in PSC are comparable to DBD and superior to non-PSC. Reduced graft survival and higher re-transplant rate following LDLT in PSC warrants further study. Consideration of DCD could help expand the donor pool in PSC. Primary sclerosing cholangitis Donation after circulatory death Living donor liver transplant graft survival patient survival donation after brain death Full Text Cite Share Download PDF Status: Published Journal Publication published 30 Oct, 2024 Read the published version in Hepatology International → Version 1 posted Editorial decision: Major Revisions Needed 21 Aug, 2024 Reviewers agreed at journal 03 Aug, 2024 Reviewers invited by journal 03 Aug, 2024 Editor assigned by journal 23 Jul, 2024 First submitted to journal 22 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4780596","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":335639886,"identity":"f4152d70-2dd5-4bac-a1ce-3c78f71e72ff","order_by":0,"name":"Shiva Kumar","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-3574-0714","institution":"Cleveland Clinic Abu Dhabi","correspondingAuthor":true,"prefix":"","firstName":"Shiva","middleName":"","lastName":"Kumar","suffix":""},{"id":335639887,"identity":"1d3a0424-a6b3-4122-af7a-e7ad669c22af","order_by":1,"name":"Songhua Lin","email":"","orcid":"","institution":"Cleveland Clinic Foundation: Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Songhua","middleName":"","lastName":"Lin","suffix":""},{"id":335639888,"identity":"2c4b5c95-fe94-4d7c-bfe1-c458daf94c49","order_by":2,"name":"Jesse D Schold","email":"","orcid":"","institution":"University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jesse","middleName":"D","lastName":"Schold","suffix":""}],"badges":[],"createdAt":"2024-07-22 09:14:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4780596/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4780596/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12072-024-10733-y","type":"published","date":"2024-10-30T16:04:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68206329,"identity":"a9b3c240-7a4f-4fc0-8bef-c42b316e09a5","added_by":"auto","created_at":"2024-11-04 16:30:42","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":635910,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptPSCFINALHepatologyInternational.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4780596/v1_covered_289c826b-2207-4527-b781-539c30aa04a7.pdf"}],"financialInterests":"","formattedTitle":"Impact Of Graft Type on Outcomes Following Liver Transplantation for Primary Sclerosing Cholangitis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"hepatology-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hepi","sideBox":"Learn more about [Hepatology International](https://www.springer.com/journal/12072)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/hepi/default.aspx","title":"Hepatology International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Primary sclerosing cholangitis, Donation after circulatory death, Living donor liver transplant, graft survival, patient survival, donation after brain death","lastPublishedDoi":"10.21203/rs.3.rs-4780596/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4780596/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background\n\nLimited data exists regarding impact of graft type on outcomes following liver transplantation (LT) in Primary Sclerosing Cholangitis (PSC). Our goal was to evaluate the impact of graft type on outcomes following LT in PSC and determine predictors of outcomes.\n\nMethods\n\nUsing SRTR, retrospective cohorts were constructed over the time period 2010-2020, divided into 2 eras: 2010–2014, 2015–2020, stratified by graft type: living donor (LDLT), donation after circulatory death (DCD) and donation after brain death (DBD). Outcome measures were graft and patient survival. Survival comparison was performed using Kaplan-Meier method and multivariable analysis using Cox proportional hazard models.\n\nResults\n\n2966 recipients underwent LT for PSC over the study period: LDLT-PSC 153 (5.2%), DCD-PSC 131 (4.4%) and DBD-PSC 2682 (90.4%). While LDLT utilization was higher in PSC (5.2% vs. 1.3%; p\u0026lt;0.001), DCD use was lower (4.4% vs. 7.2%; p\u0026lt;0.001) but increased over time (era 1 vs. 2: 3.3% vs. 5.2%; p= 0.02). Outcomes following DCD-PSC are comparable to DBD and have improved over time. Compared to DBD-PSC, there was a trend toward lower short-term graft survival following LDLT-PSC (1 Yr. 85.3 vs. 91.9; p=0.07) with higher retransplant rate (LDLT-PSC vs. DCD-PSC vs. DBD-PSC: 15% vs 11% vs 7%; p\u0026lt;0.001). Compared to non-PSC, long-term patient survival was superior in LDLT-PSC (5 Yr. 90.1 vs. 83.7%; p=0.05) and DCD-PSC (93.3 vs. 79.7%, p=0.01). On multivariable analysis, LDLT but not DCD, was associated with inferior graft survival in PSC (adjusted hazard Ratio=1.65 (1.16–2.34); p=0.005).\n\nConclusions\n\nIn PSC, utilization of LDLT is higher, while DCD use is lower but increased over time. Outcomes following DCD LT in PSC are comparable to DBD and superior to non-PSC. Reduced graft survival and higher re-transplant rate following LDLT in PSC warrants further study. Consideration of DCD could help expand the donor pool in PSC.","manuscriptTitle":"Impact Of Graft Type on Outcomes Following Liver Transplantation for Primary Sclerosing Cholangitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-29 13:35:30","doi":"10.21203/rs.3.rs-4780596/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2024-08-21T21:50:06+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-08-04T00:15:05+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-03T23:40:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-23T12:01:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Hepatology International","date":"2024-07-22T07:33:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"hepatology-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hepi","sideBox":"Learn more about [Hepatology International](https://www.springer.com/journal/12072)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/hepi/default.aspx","title":"Hepatology International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"13ee5648-2276-4731-a8cf-614943cd3088","owner":[],"postedDate":"August 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T16:21:05+00:00","versionOfRecord":{"articleIdentity":"rs-4780596","link":"https://doi.org/10.1007/s12072-024-10733-y","journal":{"identity":"hepatology-international","isVorOnly":false,"title":"Hepatology International"},"publishedOn":"2024-10-30 16:04:52","publishedOnDateReadable":"October 30th, 2024"},"versionCreatedAt":"2024-08-29 13:35:30","video":"","vorDoi":"10.1007/s12072-024-10733-y","vorDoiUrl":"https://doi.org/10.1007/s12072-024-10733-y","workflowStages":[]},"version":"v1","identity":"rs-4780596","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4780596","identity":"rs-4780596","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}