Trends and Barriers in Liver Transplantation for Patients With Decompensated Cirrhosis: A 15-Year Single-Center Cohort at a Japanese Center.

Abstract

Background and aim: Liver transplantation is the only curative treatment for end-stage liver disease; however, access remains limited, particularly in Japan, where the severe shortage of deceased donors presents a major challenge. Research comprehensively assessing the full trajectory from referral to either transplantation or death remains scarce. We aimed to analyze long-term trends and propose potential strategies to improve access to liver transplantation in Japan.

Patients and methods: This study included 616 adult patients with decompensated liver cirrhosis referred for liver transplantation. Patients were divided into 3 periods to assess temporal trends: Period 1 (2009-2013), Period 2 (2014-2018), and Period 3 (2019-2023). The primary endpoint was the liver transplantation rate among referred patients. Patient demographics, liver disease etiology and severity, and donor type were analyzed.

Results: The transplantation rate declined from 30.2% in Period 1 to 22.1% in Period 3, despite increases in follow-up rates and waitlist registrations. The availability of living donors significantly decreased over time, from 29.5% in Period 1 to 22.4% in Period 2 and 18.6% in Period 3. The rate of death without transplantation remained high (41.0%, 45.0%, and 40.0%, respectively). A higher MELD score at referral was an independent risk factor for both not undergoing transplantation and mortality among transplantation candidates.

Conclusion: Over this 15-year period, the transplantation rate declined despite increases deceased donor registrations, resulting in persistently high waitlist mortality. Our findings suggest that expanding deceased donor pool and facilitating earlier referral of transplant candidates are essential to improving access to transplantation and patient outcomes in a Japanese transplant setting.