Variation in adult living donor liver transplantation in the United States: Identifying opportunities for increased utilization

Krista L. Lentine, Tomohiro Tanaka, Huiling Xiao, Therese Bittermann, Mary Amanda Dew, Mark A. Schnitzler, Kim M. Olthoff, Jayme E. Locke, Sukru Emre, Heather F. Hunt, Ann Marie Liapakis, David A. Axelrod

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


In the United States, living donor liver transplantation (LDLT) is limited to transplant centers with specific experience. However, the impact of recipient characteristics on procedure selection (LDLT vs. deceased donor liver transplant [DDLT]) within these centers has not been described. Transplant registry data for centers that performed ≥1 LDLT in 2002–2019 were analyzed using hierarchal regression modeling to quantify the impact of patient and center factors on the adjusted odds ratio (aOR) of LDLT (vs DDLT). Among 73,681 adult recipients, only 4% underwent LDLT, varying from <1% to >60% of total liver transplants. After risk adjustment, the likelihood of receiving an LDLT rose by 73% in recent years (aOR 1.73 for 2014-2019 vs. 2002-2007) but remained lower for older adults, men, racial and ethnic minorities, and obese patients. LDLT was less commonly used in patients with hepatocellular carcinoma or alcoholic cirrhosis, and more frequently in those with hepatitis C and with lower severity of illness (Model for End-Stage Liver Disease (MELD) score < 15). Patients with public insurance, lower educational achievement, and residence in the Northwest and Southeast had decreased access. While some differences in access to LDLT reflect clinical factors, further exploration into disparities in LDLT utilization based on center practice and socioeconomic determinants of health is needed.

Original languageEnglish (US)
Article numbere14924
Pages (from-to)e14924
JournalClinical Transplantation
Issue number7
StatePublished - Jul 2023


  • access
  • disparities
  • liver transplantation
  • living donation
  • practice variation
  • Severity of Illness Index
  • United States
  • Humans
  • Male
  • Treatment Outcome
  • Living Donors
  • Liver Neoplasms/pathology
  • End Stage Liver Disease/surgery
  • Aged
  • Retrospective Studies
  • Liver Transplantation/methods

ASJC Scopus subject areas

  • Transplantation


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