Factors affecting the survival rate after living donor liver transplantation in the country of Georgia.

Abstract

Objective: We aimed to evaluate factors influencing survival after LDLT in Georgia and to identify underlying causes and strategies for improved outcomes.

Methods: A cross-sectional retrospective study including 103 living donor recipients transplanted between December 2014 and July 2024 was conducted. Survival was analyzed from the date of transplantation to death or censoring at the last available follow up. Kaplan Meier methods were used to estimate overall survival at 1, 3 and 5 years. Cox proportional hazards regression was used to evaluate factors associated with mortality.

Results: Overall survival (OS) declined significantly during the first post-transplant year. Kaplan Meier estimated patient survival was 72.8 percent at 1 year, 64.5 percent at 3 years and 63.0 percent at 5 years. The number at risk was 71 at 1 year, 47 at 3 years and 29 at 5 years. Among 103 LDLT recipients, 38 deaths occurred and 65 patients were censored alive during follow up. Median observed follow up was 878 days, IQR 286 to 1989. In the primary Cox proportional hazards model, intra or postoperative complications were associated with higher mortality, adjusted HR 2.67, 95 percent CI 1.38 to 5.16, p = 0.004. HCC was also associated with higher mortality, adjusted HR 3.37, 95 percent CI 1.65 to 6.91, p = <0.001. Schoenfeld residual based tests did not indicate violation of the proportional hazards assumption.

Conclusion: This study offers valuable insight into post-transplant LDLT outcomes in Georgia. Identification of key clinical risk factors highlights opportunities for targeted intervention. Given that Georgia's short-term survival rates remain lower than those reported in high-income countries, optimizing modifiable risk factors may improve long-term outcomes.