Abstract
Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education, and income. Data from September 2023 to June 2024 were prospectively collected through the International LDLT Registry, involving 70 institutions from 26 countries. This prospective global cohort included 1575 pairs (3150 cases). Donors from very high HDI regions had a higher prevalence of comorbidities (17.4%) than those from low HDI regions (1.2%; P < .001). High HDI regions showed lower donor complication rates (9.8%) than lower HDI regions (21.9%; P < .001). Multivariable analysis indicated significantly reduced short-term postoperative donor morbidity in very high HDI regions (odds ratio, 0.32; 95% confidence interval, 0.23-0.44; P < .001). Failure-to-rescue rates were substantially higher in low HDI regions (83.3% vs 2.3%; P < .001). The study highlights the significant disparities in LDLT practices and short-term outcomes across HDI levels, emphasizing the need for global cooperation to standardize practices and enhance care quality to ensure equitable access to liver transplantation worldwide.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1735-1745 |
| Number of pages | 11 |
| Journal | American Journal of Transplantation |
| Volume | 25 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2025 |
Keywords
- Gini coefficient
- Human Development Index (HDI)
- donor safety
- global health disparities
- health equity
- living donor liver transplantation (LDLT)
- registry
- socioeconomic impact
- transplantation outcomes
Access to Document
Other files and links
Fingerprint
Dive into the research topics of 'Global variation in living donor liver transplantation practices impacts donor and recipient short-term outcomes: Initial insights from the International LDLT Registry'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: American Journal of Transplantation, Vol. 25, No. 8, 08.2025, p. 1735-1745.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global variation in living donor liver transplantation practices impacts donor and recipient short-term outcomes
T2 - Initial insights from the International LDLT Registry
AU - Chief Investigators, Investigators
AU - Rela, Mohamed
AU - Pomfret, Elizabeth
AU - Egawa, Hiroto
AU - Co-Chief Investigator, Investigator
AU - Bhangui, Prashant
AU - Founders, R&D Team, R&D Team
AU - Raptis, Dimitri A.
AU - Berenguer, Marina
AU - Spiro, Michael
AU - Rela, Mohamed
AU - Scientific Committee, Committee
AU - Chaudhary, Abhideep
AU - Humar, Abhinav
AU - Shaked, Abraham
AU - Chan, Albert
AU - Chieh, Alfred Kow Wei
AU - Jafarian, Ali
AU - Soin, Arvinder Singh
AU - Davidson, Brian
AU - Goh, Brian
AU - Chen, Chao Long
AU - Miller, Charles
AU - Wang, Chih Chi
AU - Toso, Christian
AU - Azoulay, Daniel
AU - Cherqui, Daniel
AU - Kruger, Deirdre
AU - Balci, Deniz
AU - Manas, Derek
AU - Bezinover, Dmitri
AU - Joo, Dong Jin
AU - Testa, Giuliano
AU - Kabacam, Gokhan
AU - Sapisochin, Gonzalo
AU - Eilers, Helge
AU - Ozden, Ilgin
AU - Findlay, James Y.
AU - Pomposelli, James
AU - Lerut, Jan
AU - Dong, Jia Hong
AU - Liu, Jiang
AU - Fung, John
AU - Roberts, John P.
AU - Kim, Joseph
AU - He, Kang
AU - Olthoff, Kim
AU - Hasegawa, Kiyoshi
AU - Hashimoto, Koji
AU - Man, Kwan
AU - Watt, Kymberly
AU - Patel, Madhukar S.
AU - Cattral, Mark
AU - Ghobrial, Mark
AU - Malago, Massimo
AU - Kasahara, Mureo
AU - Ascher, Nancy
AU - Selzner-Malekkiani, Nazia
AU - Goldaracena, Nicolas
AU - Bhangui, Pooja
AU - Jalan, Rajiv
AU - Kamel, Refaat
AU - Adam, Rene
AU - Troisi, Roberto I.
AU - Alqahtani, Saleh A.
AU - Nagral, Sanjay
AU - Zheng, Shusen
AU - Nadalin, Silvio
AU - Asthana, Sonal
AU - McCluskey, Stuart A.
AU - Gupta, Subhash
AU - Eguchi, Susumu
AU - Pan, Terry
AU - Sakai, Tetsuro
AU - Wong, Tiffany Cho Lam
AU - Mas, Valeria R.
AU - Vohra, Vijay
AU - Vij, Vivek
AU - Polak, Wojciech
AU - Andraus, Wellington
AU - Tokat, Yaman
AU - Soejima, Yuji
AU - Scientific Advisory Board, Data Monitoring Committee, Advisory Board, Data Monitoring Committee
AU - Mayr, Andreas
AU - Dominguez, Beatriz
AU - Muller, Elmi
AU - Rando, Karina
AU - Mueller, Thomas
AU - Data Management Committee, Management Committee
AU - Mayr, Andreas
AU - Hidalgo Salinas, Camila
AU - Raptis, Dimitri A.
AU - Spiro, Michael
AU - Syn, Nicholas
AU - Tinguely, Pascale
AU - Writing Committee, Committee
AU - Raptis, Dimitri A.
AU - Spiro, Michael
AU - Lewis, Toby
AU - Raja, Meera
AU - Dominguez, Beatriz
AU - Berenguer, Marina
AU - Rela, Mohamed
AU - Management Committee, Committee
AU - Kirchner, Varvara A.
AU - De Martin, Eleonora
AU - Shingina, Alexandra
AU - Rammohan, Ashwin
AU - Vinaixa, Carmen
AU - Borja-Cacho, Daniel
AU - Nasralla, David
AU - Patel, Dhupal
AU - Wilson, Elizabeth Ann
AU - Prosperi, Enrico
AU - Alconchel, Felipe
AU - Roll, Garrett
AU - Abdul, Hakeem
AU - Liu, Jiang
AU - Mathew, Johns Shaji
AU - Bzeizi, Khalid
AU - Patel, Madhukar S.
AU - Izzy, Manhal
AU - De Santibanes, Martin
AU - Zayed, Naglaa
AU - Keskin, Onur
AU - Andacoglu, Oya
AU - Abreu, Phillipe
AU - Khan, Qasim
AU - Chadha, Ryan
AU - Alghamdi, Saad
AU - Shankar, Sadhana
AU - Shaker, Tamer
AU - Fernandez, Tom
AU - Yoon, Uzung
AU - Al-Hamoudi, Waleed
AU - Administration Committee, Committee
AU - Kantsedikas, Ilya
AU - Marquez, Kris Ann H.
AU - Elmikkaoui, Bilal
AU - Wells, Gemma
AU - Alshibi, Leen
AU - Zachiotis, Marinos
AU - Raja, Meera
AU - Kareem, Sami A.
AU - Bousi, Stelios Elion
AU - Lewis, Toby
AU - Previous Members, Members
AU - Turner, Benedict
AU - Chikkala, Bhargava
AU - Salinas, Camila Hidalgo
AU - Melloul, Emmanuel
AU - Syeda, Gulbahar
AU - Patel, Krishnakumure
AU - Reji, Nidhi
AU - Machairas, Nikolaos
AU - Tinguely, Pascale
AU - Staubli, Sebastian
AU - Ghani, Shahi Abdul
AU - Grover, Steen
AU - Academic Headquarters, Headquarters
AU - Oberkofler, Christian
AU - Country Leaders, Leaders
AU - Fernandez, Thomas
AU - Hakeem, Abdul Rahman
AU - Chan, Albert
AU - Chorley, Alicia
AU - Galli, Alessandro
AU - Kow, Alfred
AU - Malik, Ashish
AU - Rammohan, Ashwin
AU - Pulitano, Carlo
AU - de Magnée, Catherine
AU - Zamora-Valdes, Daniel
AU - Mikulich, Danko
AU - Kim, Deock Gie
AU - Joo, Dong Jin
AU - Gago, Felipe Alconchel
AU - Lurje, Georg
AU - Torres, Gustavo
AU - Eilers, Helge
AU - Ohdan, Hideki
AU - Braun, Hillary
AU - Montasser, Iman
AU - Balradja, Inbaraj
AU - Shapiro, James
AU - Ullah, Kaleem
AU - Sun, Li Ying
AU - de Boer, Marieke
AU - De Santibañes, Martin
AU - Emara, Moataz
AU - Khan, Muhammad Yasir
AU - Zayed, Naglaa
AU - Selzner, Nazia
AU - Goldaracena, Nicholas
AU - Keskin, Onur
AU - Minnee, Robert
AU - Chadha, Ryan
AU - Alabbad, Saleh
AU - Nah, Shireen
AU - Angelo Zaragoza, Simone Santoro
AU - Beridze, Sophio
AU - McCluskey, Stuart
AU - Rahman, Suehana
AU - Junrungsee, Sunhawit
AU - Klair, Tarunjeet
AU - Saluja, Vandana
AU - Zhu, Zhi Jun
AU - Transplant Hepatology Working Group, Hepatology Working Group
AU - Shingina, Alexandra
AU - Al-Judaibi, Bandar
AU - De Martin, Eleonora
AU - Montasser, Iman
AU - Bzeizi, Khalid
AU - Watt, Kymberly
AU - Izzy, Manhal
AU - Berenguer, Marina
AU - Zayed, Naglaa
AU - Selzner-Malekkiani, Nazia
AU - Khan, Qasim
AU - Jalan, Rajiv
AU - Alghamdi, Saad
AU - Alqahtani, Saleh A.
AU - Beridze, Sophio
AU - Al-Hamoudi, Waleed
AU - Contributing Members, Members
AU - Alotaibi, Abdulaziz F.
AU - Jagdale, Abhijit
AU - Humar, Abhinav
AU - Konietzko, Achim
AU - Draz, Ahmed R.I.
AU - Sabry, Ahmed M.
AU - Shehta, Ahmed
AU - Mehrez, Ahmed
AU - Foda, Ahmed S.
AU - Taha, Ahmed M.I.
AU - Dogrul, Ahmet B.
AU - Fukuda, Akinari
AU - Chan, Albert
AU - Montano-Loza, Aldo J.
AU - Parente, Alessandro
AU - Chorley, Alicia
AU - Della Penna, Andrea
AU - Duarte, Andres
AU - Barbas, Andrew
AU - Pillai, Anjana A.
AU - Angelis, Apostolos
AU - Campana, Ariel G.
AU - Arnetta, Arnetta Naomi
AU - Oezcelik, Arzu
AU - Demir, Arzu
AU - Shah, Ashesh
AU - Singhal, Ashish
AU - Khalil, Ashraf
AU - Dahaba, Ashraf A.
AU - Rammohan, Ashwin
AU - Salah, Ayman
AU - Catellani, Barbara
AU - Fadel, Bashir A.
AU - Strobele, Bernd
AU - Elinoff, Beth
AU - Balbi, Beth
AU - Prabha, Bharani
AU - Elmikkaoui, Bilal
AU - Ruhi, Caglar
AU - Wilmans, Carla
AU - de Magnee, Catherine
AU - Seng GAN, Chin
AU - Hughes, Christopher
AU - Borja-Cacho, Daniel
AU - Caracciolo, Daniela
AU - Tholey, Danielle
AU - Fritze, Danielle
AU - Reynolds, David M.
AU - Kostrouch, David
AU - Sass, David
AU - Balci, Deniz
AU - DiSabato, Diego
AU - Broering, Dieter C.
AU - Raptis, Dimitri A.
AU - Moris, Dimitrios
AU - Mostafa, Dina K.
AU - Parbhoo, Dinen
AU - El-Gharabawy, Doaa A.R.
AU - Kostková, Dominika
AU - Domi, Dorina
AU - Abdel-Khalek, Ehab E.
AU - Hassan, Ehab M.S.
AU - Riani, Eliano Bonaccorsi
AU - Lytvak, Ellina
AU - İsazade, Elvin
AU - Winter, Erin
AU - Raziq, Fathima A.T.
AU - Martin, Fauda
AU - Krendl, Felix J.
AU - Saner, Fuat
AU - Gondolesi, Gabriel E.
AU - Sonmez, Gamze
AU - Sotiropoulos, Georgios C.
AU - Razzak, Ghazi F.A.
AU - Abu Sharia, Ghena R.
AU - Meeberg, Glenda
AU - Ozturk, Gurkan
AU - Torres, Gustavo G.
AU - Uchida, Hajime
AU - Karakayali, Hamdi
AU - Oswari, Hanifah
AU - Kato, Hirotaka
AU - Haq, Ihsanul
AU - Montesser, Iman F.
AU - Shariffuddin, Ina I.
AU - Balescu, Irina
AU - Rodriguez, Ivan E.
AU - Krishnamurthy, Jagadeesh
AU - Cisek, Jaime
AU - Shapiro, James A.M.
AU - Schmidt, Jennifer
AU - Singh, Jessica
AU - Uño, Jimmy W.
AU - Froněk, Jiří
AU - Caicedo, Juan C.
AU - Fasolo, Juan Cruz
AU - Jeffery, Julie
AU - Ravindra, Kadiyala
AU - Mannogaran, Kajanshy
AU - Dokus, Katherine
AU - Degawa, Kazuki
AU - William, Kerolos Y.
AU - Dajani, Khaled Z.
AU - Olthoff, Kim M.
AU - Dhanireddy, Kiran
AU - A, Kris
AU - Marquez, Hervera
AU - Rinaldy, Kshetra
AU - Vardar, Kubra
AU - Jnied, Laith Y.Z.
AU - Chishtee, Laraib M.F.
AU - Matevish, Lauren
AU - Montes, Leonardo
AU - Sun, Li Ying
AU - Wei, Lin
AU - Knipling, Lois
AU - Novellis, Lucia
AU - Auler, Lucio J.F.
AU - Podesta, Luis G.
AU - Meteini, Mahmoud E.L.
AU - Singh, Manoj K.
AU - Schulze, Maren
AU - Van Den Hove D'Ertsenryck, Marguerite
AU - Villa, Mariana Chavez
AU - Beretta, Marisa
AU - Kočík, Matěj
AU - Byrne, Matthew
AU - Gryga, Megan
AU - Huseynova, Mehriban
AU - Bingol-Kologlu, Meltem
AU - Zubkov, Micaella
AU - Lucas, Michelle
AU - Bahaa, Mohamed
AU - Abdel-Wahab Aly, Mohamed
AU - Abdou, Mohamed B.
AU - Alhazaimeh, Mohammad A.K.
AU - Al-Rahman, Mohammed
AU - Faisal, Mohammed
AU - Schmelzle, Moritz
AU - ElShazly, Mostafa
AU - Issa, Muhammad A.
AU - Qadeer, Muhammad A.
AU - Khan, Muhammad Y.
AU - Zaheen, Muhammad
AU - Tuul, Munkhbold
AU - Zayed, Naglaa
AU - Makhlouf, Nahed A.
AU - Bacalbasa, Nicolae
AU - Richter, Nicolas
AU - Bergmann, Nicole
AU - Machairas, Nikolaos
AU - Bayramov, Nuru
AU - Kemmer, Nyingi
AU - Keskin, Onur
AU - Andacoglu, Oya M.
AU - Selvi, Ozlem C.
AU - Peralta, Peregrina
AU - Kron, Philipp
AU - Bhanji, Rahima
AU - Chimakurthi, Ramu
AU - Alshwabkeh, Rashed A.A.
AU - Ravikiran, S. K.
AU - Maciel, Renato T.
AU - Walruff, Renee
AU - Minnee, Robert
AU - Porte, Robert
AU - Alejandro, Roberto Hernandez
AU - Barth, Rolf
AU - Terng NG, Ruey
AU - Kulkarni, Rugved
AU - Oberhuber, Rupert
AU - Komine, Ryuji
AU - Shankar, Sadhana
AU - Kara, Salih
AU - Abu-Gazala, Samir
AU - Goja, Sanjay
AU - Yadav, Sanjay K.
AU - Sakamoto, Seisuke
AU - Kubal, Shekhar
AU - Mogawer, Sherif
AU - Hsu, Shih Chao
AU - Nah, Shireen A.
AU - Nadalin, Silvio
AU - Rashid, Sohail
AU - Schneeberger, Stefan
AU - Di Sandro, Stefano
AU - Hartleif, Steffen
AU - Kykalos, Stylianos
AU - Gupta, Subhash
AU - Mushtaq, Sumera
AU - Baker, Talia
AU - Klair, Tarunjeet
AU - Kodama, Tasuku
AU - Bitterman, Therese
AU - Yilmaz, Tonguc U.
AU - Rahayatri, Tri H.
AU - Neumann, Ulf P.
AU - Baumann, Ulrich
AU - Yoon, Uzung
AU - Gunasekaran, Vasanthakumar
AU - Dhakshinamoorthy, Vijayanand
AU - Stephenne, Xavier
AU - Massoud, Yasmine
AU - Miyazaki, Yuki
AU - Yanagi, Yusuke
AU - Dietch, Zachary
AU - Abbas, Zaigham
AU - Kuloglu, Zarife
AU - Hyder, Zeeshan
AU - Zhu, Zhi Jun
N1 - Publisher Copyright: © 2025
PY - 2025/8
Y1 - 2025/8
N2 - Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education, and income. Data from September 2023 to June 2024 were prospectively collected through the International LDLT Registry, involving 70 institutions from 26 countries. This prospective global cohort included 1575 pairs (3150 cases). Donors from very high HDI regions had a higher prevalence of comorbidities (17.4%) than those from low HDI regions (1.2%; P < .001). High HDI regions showed lower donor complication rates (9.8%) than lower HDI regions (21.9%; P < .001). Multivariable analysis indicated significantly reduced short-term postoperative donor morbidity in very high HDI regions (odds ratio, 0.32; 95% confidence interval, 0.23-0.44; P < .001). Failure-to-rescue rates were substantially higher in low HDI regions (83.3% vs 2.3%; P < .001). The study highlights the significant disparities in LDLT practices and short-term outcomes across HDI levels, emphasizing the need for global cooperation to standardize practices and enhance care quality to ensure equitable access to liver transplantation worldwide.
AB - Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education, and income. Data from September 2023 to June 2024 were prospectively collected through the International LDLT Registry, involving 70 institutions from 26 countries. This prospective global cohort included 1575 pairs (3150 cases). Donors from very high HDI regions had a higher prevalence of comorbidities (17.4%) than those from low HDI regions (1.2%; P < .001). High HDI regions showed lower donor complication rates (9.8%) than lower HDI regions (21.9%; P < .001). Multivariable analysis indicated significantly reduced short-term postoperative donor morbidity in very high HDI regions (odds ratio, 0.32; 95% confidence interval, 0.23-0.44; P < .001). Failure-to-rescue rates were substantially higher in low HDI regions (83.3% vs 2.3%; P < .001). The study highlights the significant disparities in LDLT practices and short-term outcomes across HDI levels, emphasizing the need for global cooperation to standardize practices and enhance care quality to ensure equitable access to liver transplantation worldwide.
KW - Gini coefficient
KW - Human Development Index (HDI)
KW - donor safety
KW - global health disparities
KW - health equity
KW - living donor liver transplantation (LDLT)
KW - registry
KW - socioeconomic impact
KW - transplantation outcomes
UR - https://www.scopus.com/pages/publications/105007013959
U2 - 10.1016/j.ajt.2025.04.008
DO - 10.1016/j.ajt.2025.04.008
M3 - Article
C2 - 40252923
AN - SCOPUS:105007013959
SN - 1600-6135
VL - 25
SP - 1735
EP - 1745
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -