Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores

Chok, Kenneth S. H.; Chan, See Ching; Fung, James; Cheung, Tan To; Chan, Albert; Fan, Sheung Tat; Lo, Chung Mau

doi:10.1016/s1499-3872(13)60042-9

Cited by 34 publications

(32 citation statements)

References 21 publications

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“…2,5 In brief, donor workup was in a stepwise fashion. Apart from physical wellbeing and blood group compatibility, psychological readiness as assessed by an experienced clinical psychologist was also a criterion for donation.…”

Section: Methodsmentioning

confidence: 99%

“…1 However, it has been reported that with the required expertise and enough experience, LDLT for patients with a MELD score >25, whereas <35 is safe with good outcomes, even if the grafts are small for size. [1][2][3] A question after this is ''Should LDLT be offered to patients with MELD scores !35?'' At our center, the only liver transplant center in Hong Kong, 15% to 20% of patients on the liver transplant waiting list have ultrahigh MELD scores-that is, MELD scores !35.…”

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confidence: 99%

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Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores ≥35 in a Hepatitis-B Endemic Area

et al. 2017

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores ≥35 in a Hepatitis-B Endemic Area

et al. 2017

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“…However, high MELD scores above than or equal to 35 alone should not be an absolute contraindication of LDLT. Another previous study reported that patients with high MELD scores had significantly more early postoperative complications, but comparable hospital mortality, graft survival, and overall survival compared to patients with low MELD scores (16).…”

Section: Discussionmentioning

confidence: 90%

Pre-transplant Predictors for 3-Month Mortality after Living Donor Liver Transplantation

Lee

Kim

Kwon

et al. 2014

Korean J Transplant

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Background: High model for end-stage liver disease (MELD) scores (≥35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT.Methods: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012.Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively.Results: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores ≥35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores ≥35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively.Conclusions: Patients with both risk factors (ICU care before LDLT and MELD scores ≥35) should be cautiously considered for treatment with LDLT.

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“…In the past, patients with high MELD scores were denied LDLT because it would be unwise to put donors in risk for recipient outcomes that would be inferior. However, studies have shown that LDLT can provide patients who have high MELD scores with excellent graft function and patient survival[24,40,41]. The preference for RL graft is due to the shorter cold ischemic time and, in general, greater liver mass.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

She¹,

Chok²,

Chan³

et al. 2017

WJG

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AIMTo analyze the outcomes of living-donor liver transplantation (LDLT) using left-lobe (LL) or right-lobe (RL) small-for-size (SFS) grafts.METHODSProspectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short- and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight (GW) to recipient standard liver volume (RSLV) (GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTSTotally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age (median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women (165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW (P < 0.0001), GW/RSLV (P < 0.0001), and graft cold ischemic time (P = 0.007). When it comes to postoperative complication, the groups were comparable (P = 0.105). Five patients died in hospital, 4 (2%) in the RL-LDLT group and 1 (5.3%) in the LL-LDLT group (P = 0.918). There were 38 graft losses, 33 (16.6%) in the RL-LDLT group and 5 (26.3%) in the LL-LDLT group (P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group (95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates (RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSIONThe use of SFS graft in LDLT requires careful tailor-made surgical planning and meticulous operation. LL-LDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

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Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores

Cited by 34 publications

References 21 publications

Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores ≥35 in a Hepatitis-B Endemic Area

Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores ≥35 in a Hepatitis-B Endemic Area

Pre-transplant Predictors for 3-Month Mortality after Living Donor Liver Transplantation

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

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