Mortality and associated factors among patients who underwent liver transplantation in South Korea from 2017 to 2021: a retrospective observational study.

Abstract

Purpose: Liver transplantation (LT) in South Korea dates back to 1988. However, Asians may be reluctant to donate their organs because of the influence of their traditional religious and philosophical beliefs. We aimed to investigate the mortality and associated factors among patients admitted after LT in South Korea.

Methods: The South Korean National Health Insurance Service database was used as a data source. All adult patients who underwent LT between January 1, 2017 and December 31, 2021 (5 years) were included in the study.

Results: A total of 7,316 patients were included in the analysis (living donor LT [LDLT], 5,412; deceased donor LT [DDLT], 1,904). The 1-year mortality rate was 12.8% (LDLT, 8.2%; DDLT, 25.9%; P < 0.001), and the postoperative complication rate was 26.8% (LDLT, 16.7%; DDLT, 55.6%; P < 0.001). The average length of hospital stay was 30.8 days, and that in the intensive care unit was 6.1 days. The total mean cost was 69,954 US dollars, and the self-cost was 6,008 US dollars. After adjusting confounders, DDLT (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.79-5.20; P < 0.001), re-LDLT (HR, 4.82; 95% CI, 3.10-7.40; P < 0.001), re-DDLT (HR, 4.65; 95% CI, 3.55-7.12; P < 0.001), and postoperative complications (HR, 1.72; 95% CI, 1.39-2.12; P < 0.001) were potential risk factors for higher 1-year mortality after transplantation.

Conclusion: LDLT was performed at a higher rate in South Korea and was associated with lower mortality and fewer postoperative complications than DDLT. Redo LT led to higher mortality rates.