High MELD score does not adversely affect outcome of living donor liver transplantation: Experience in 1000 recipients

Abstract

In countries where deceased organ donation is scarce, there is a big gap between demand and supply of organs and living donor liver transplantation (LDLT) plays an important role in meeting this unmet need. This study was conducted to analyze the effect of pretransplant Model for End-stage Liver Disease (MELD) score on outcomes following LDLT. The outcome of 1000 patients who underwent LDLT from July 2010 to March 2015 was analyzed retrospectively. Patients were grouped into low MELD<25 and high MELD ≥25 score to compare short-term outcomes. Cumulative overall survival rates were calculated using Kaplan-Meier methods. A total of 849 recipients were in low MELD group (Mean MELD=16.90±9.2) and 151 were in high MELD group (Mean MELD=28.77±7.2). No significant difference in etiology of CLD was observed between groups except for a higher prevalence of hepatitis C virus (29.6% vs 19.9%, P=.01) in low MELD patients. No significant difference was observed in 1-year survival (88.5% vs 84.1%, P=.12) between the groups. The multivariate analysis showed that pretransplant MELD score does not predict survival of recipients. Pretransplant high MELD score does not adversely affect outcomes after LDLT. In view of shortage of deceased organs, LDLT can be a good option in high MELD recipients.

Successful introduction of Model for End-stage Liver Disease scoring in deceased donor liver transplantation in Korea: analysis of first 1 year experience at a high-volume transplantation center

“…Despite these difficulties, patient mortality rates remained unchanged, implicating that the MELD score per se is not an irreversible factor for poor post-transplant prognosis. 13 14 …”

Evolution of Liver Transplantation Program in Shiraz, Iran

“…In multivariate analysis only MELD/PELD score, but not the age, was related to recipients' survival. There are controversial reports on the association of baseline MELD/PELD score with survival (28)(29)(30)(31).…”

Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety

“…Disease severity is a significant factor that determines graft outcomes, and MELD score has been used to quantify the severity of recipient disease objectively. A study of 1000 consecutive LDLT recipients from the same institution showed that outcomes of high MELD (≥25) recipients were comparable to those of patients with a low MELD (<25) score when GRWR was >0.8% and good AS drainage by MHV was ensured …”

“…‡Our modification of Neumann et al (2006) classification. § Yadav et al (2017). (B) Algorithm for MHV retrieval.…”

“…This study was approved by the institutional review board (institutional review board number MICR‐782/2017). Preoperative donor and recipient selection criteria have been described elsewhere previously …”