Liver only transplants in the UK

Question 2: In terms of survival benefit

2915 (81%) deceased donor after brain death (DBD) liver transplants Data from UK Transplant Registry (UKTR) Transplant survival: composite outcome of graft and patient survival Conditional analysis on patients surviving at 30 and 90 days 3575 first elective adult NHS group 1 orthotopic liver only txs from deceased donor 2915 (81%) deceased donor after brain death (DBD) liver transplants 660 (19%) donor after circulatory death (DCD) liver transplants 1 January 2006 to 31 December 2013 Three end points post-transplant considered separately 30 days, 1 and 5 years Univariate transplant survival estimates obtained using Kaplan-Meier estimation method survival compared using log-rank test Multivariate Cox regression analysis performed to identify factors associated with transplant survival time from liver transplant to earlier of graft failure or patient death (deaths with a functioning graft included as events)

Note: ABO match, time to transplant and donor BMI influential at 30 days but not later on. Donor age influential in the long term

DBD survival ~ 80% at 5 years DCD survival ~ 70% at 5 years Waiting list survival ~ 40% at 5 years Left panel: Survival post transplant. Events: graft failure or patient death, the earliest of the two Cohort: 3575 first elective adult NHS group 1 orthotopic liver only txs from deceased donor 2915 (81%) deceased donor after brain death (DBD) liver transplants 660 (19%) donor after circulatory death (DCD) liver transplants 1 January 2006 to 31 December 2013 Right panel: Survival post registration. Events: patient death 5071 first, adult, elective liver only registrations in the UK

Size: +- 20 kg in donor-recipient match Blood group compatibility: O donor can go to any recipient; A donor can only go to groups A or AB; B donor can only go to group B or AB; AB donor can only go to group AB.

Emphasise that this is a different cohort than before Emphasise that this is a different cohort than before. These are registrations whereas, previously, looking at transplants

Benefit conclusion: It is possible that the HR under- or over-estimates the effect of DCD liver tx for certain patient subgroups