Predictors of donor follow-up after living donor liver transplantation

Abstract

Donor safety in living liver donation is of paramount importance, however, information on long-term outcomes is limited by incomplete follow-up. We sought to ascertain factors that predict post-donation follow-up in 456 living liver donors in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Completed donor follow-up was defined as physical, phone, or laboratory contact at a given time point. Univariate and multivariable mixed effects logistic regression models were developed to predict completed follow-up using donor and recipient demographic and clinical data and donor quality of life data. 90% of donors completed follow-up in the first three months, 83% at year 1; completed follow-up ranged from 57% to 72% in years 2–7 and from 41% to 56% in years 8–10. The probability of completed follow-up in the first year was higher for white donors (odds ratio (OR)=3.27, 95% confidence interval (CI)=1.25–8.58), but lower for donors whose recipients had hepatitis C virus or hepatocellular carcinoma (OR=0.34, 95% CI=0.17–0.69). After the first year, older age at donation predicted more complete follow-up. There were significant center differences at all time points (OR range 0.29–10.11), with center variability in both return for in-center visits and in the use of phone/long distance visits. Donor follow-up in the first year post-donation was excellent but decreased with time. Predictors of follow-up varied based on the time since donation. Adapting center best practices, enhanced by using telephone and social media to maintain contact with donors, represents a significant opportunity to gain valuable information about long-term donor outcomes.

Long-Term Medical and Psychosocial Outcomes in Living Liver Donors

“…For example, few A2ALL donors had follow-up >6 years (24); it is unknown whether additional complications may develop later. In addition, after the first year or so postdonation, many donors may have sought care at facilities other than the transplant center.…”

“…In the United States, the Scientific Registry of Transplant Recipients is conducting a feasibility study to explore whether a living kidney and liver donor registry could be formed to collect long-term follow-up information (46). Although difficulties in following donors for either research or clinical surveillance and care have been discussed in many forums (14,24), such information is critical for understanding—and potentially intervening upon—the risks and potential sequelae of living liver donation. These activities will help to ensure that donor safety continues to come first.…”

Healthcare Resource Utilization After Living Liver Donation: A Retrospective Case–Control Study

“…Living liver donors are scheduled for routine follow-up after liver donation to ensure donor safety, and our data included routine checkup visits in living liver donors. As most institutions have a follow-up visit protocol similar to the clinical protocols of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, 21 4–6 scheduled postdonation routine checkup visits are included in the outpatient department visits during the first year. Therefore, the number of outpatient department visits in donors unrelated to liver donation may be considered similar to the second year and the years thereafter.…”

Survey of Living Organ Donors’ Experience and Directions for Process Improvement

“…A recent analysis of kidney donors by Schold et al reported that women are more compliant with postdonation follow-up as are those who are older, married, and more educated which could translate to a higher survey response rate 22 ; white race and older age have also been found to be correlated with closer follow-up in the liver donor population. 23 Still, despite a higher prevalence of end-stage renal disease, minorities are persistently underrepresented as donors and living donor recipients—as are lower income individuals. A recent consensus conference 24 suggested areas for intervention to address the multifactorial roots of this disparity; among these are removing financial disincentives (discussed earlier) and increasing collaborative research on ways to break down the barriers to transplant or donation.…”