Living Transplantation in Adult, From Living Donor. A Valid Option

González, Enrique Moreno

doi:10.1016/j.cireng.2017.05.010

Cited by 1 publication

(1 citation statement)

References 7 publications

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“…Therefore, a considerable risk exists for perioperative complications such as vascular complications, biliary stricture or leak, early graft dysfunction or early allograft loss necessitating re-transplant. Nevertheless, several studies emanating from the experienced centers of the world have outlined equivalent or improved graft survival outcomes after LDLT compared to DDLT irrespective of the consideration of MELD score [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Historically, the reported incidence of vascular complications following LDLT was up to 9%; however, with increasing experience in LDLT, the reported incidence in the contemporary literature is comparable to the incidence in DDLT in both high- and low-MELD recipients [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing High- and Low-Model for End-Stage Liver Disease Living-Donor Liver Transplantation to Determine Clinical Efficacy: A Systematic Review and Meta-Analysis (CHALICE Study)

Jayant,

Cotter,

Reccia

et al. 2023

JCM

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Introduction: Various studies have demonstrated that low-Model for End-Stage Liver Disease (MELD) living-donor liver transplant (LDLT) recipients have better outcomes with improved patient survival than deceased-donor liver transplantation (DDLT) recipients. LDLT recipients gain the most from being transplanted at MELD <25–30; however, some existing data have outlined that LDLT may provide equivalent outcomes in high-MELD and low-MELD patients, although the term “high” MELD is arbitrarily defined in the literature and various cut-off scores are outlined between 20 and 30, although most commonly, the dividing threshold is 25. The aim of this meta-analysis was to compare LDLT in high-MELD with that in low-MELD recipients to determine patient survival and graft survival, as well as perioperative and postoperative complications. Methods: Following PROSPERO registration CRD-42021261501, a systematic database search was conducted for the published literature between 1990 and 2021 and yielded a total of 10 studies with 2183 LT recipients; 490 were HM-LDLT recipients and 1693 were LM-LDLT recipients. Results: Both groups had comparable mortality at 1, 3 and 5 years post-transplant (5-year HR 1.19; 95% CI 0.79–1.79; p-value 0.40) and graft survival (HR 1.08; 95% CI 0.72, 1.63; p-value 0.71). No differences were observed in the rates of major morbidity, hepatic artery thrombosis, biliary complications, intra-abdominal bleeding, wound infection and rejection; however, the HM-LDLT group had higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. Conclusions: The high-MELD LDLT group had similar patient and graft survival and morbidities to the low-MELD LDLT group, despite being at higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. The data, primarily sourced from high-volume Asian centers, underscore the feasibility of living donations for liver allografts in high-MELD patients. Given the rising demand for liver allografts, it is sensible to incorporate these insights into U.S. transplant practices.

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