What does this research mean for the field?

Living donor liver transplantation is a feasible alternative to deceased donor transplantation for critically ill ICU patients, though pretransplant ICU stays over 14 days and SOFA scores of 15 or higher independently predict in-hospital mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate liver transplantation outcomes in critically ill ICU patients and assess the feasibility of living donor liver transplantation.

July 9, 2026Open Access

Outcomes of liver transplantation in critically ill patients admitted to an intensive care unit: a retrospective study

DWDae Hyeon WonUlsan College YYYoung‐In YoonUlsan College SKSung‐Min KimUlsan College

Key Points

This research aims to evaluate liver transplantation outcomes in critically ill ICU patients and assess the feasibility of living donor liver transplantation.
Retrospective cohort study of 194 ICU-admitted patients undergoing liver transplantation from January 2018 to December 2023.
Patients classified into living donor liver transplantation (LDLT, n=58) and deceased donor liver transplantation (DDLT, n=136) groups.
Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality.
DDLT recipients had higher model for end-stage liver disease scores (37.0 vs. 29.9, P<0.001) and SOFA scores (15.9 vs. 13.8, P<0.001).
One-year overall survival rates were higher in the LDLT group (74.8%) compared to DDLT group (63.1%; P=0.081).
SOFA scores ≥15 (OR, 2.13; P=0.041) and ICU stay >14 days (OR, 2.00; P=0.048) were identified as independent predictors of in-hospital mortality.

Abstract

Background: Liver transplantation (LT), the only curative treatment for patients with advanced liver disease that can progress to hepatic failure, remains challenging in critically ill patients requiring intensive care unit (ICU) management owing to multiorgan dysfunction and hemodynamic instability. In Korea, where deceased donor organs are limited, living donor LT (LDLT) may provide a timely and life-saving alternative; however, its feasibility for ICU patients remains uncertain. Methods: This retrospective cohort study included 194 ICU-admitted patients who underwent LT between January 2018 and December 2023. Patients were classified into LDLT (n=58) and deceased donor LT (DDLT, n=136) groups. We compared baseline characteristics, perioperative outcomes, and survival rates between the groups. Using multivariable logistic regression analysis, independent predictors of in-hospital mortality were analyzed. Results: DDLT recipients had higher model for end-stage liver disease (37.0 vs. 29.9, P14 days (OR, 2.00; P=0.048) were independent predictors of in-hospital mortality. Conclusions: LDLT may be a feasible and potentially life-saving for critically ill ICU patients when deceased donor organs are unavailable. Prolonged pretransplant ICU stay was independently associated with higher mortality, and timely transplantation before irreversible multiorgan failure is crucial. Early donor identification, careful recipient selection, and a multidisciplinary approach are essential for optimizing patient outcomes.

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