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

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.