Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients

Abstract

A dult-to-adult right hepatic lobe living donor liver transplantation (LDLT) has grown rapidly in the setting of a cadaveric organ shortage. 1 Initial outcomes have been promising for both recipients and donors. 2,3 Nevertheless, this treatment must be approached with careful forethought. Criteria for both recipient and donor selection are just evolving. United Network of Organ Sharing (UNOS) status 2A proved to be an important recipient exclusionary criterion because such patients have threefold greater mortality compared with recipients of cadaveric livers. 4 In February 2002, the national organ allocation policy for liver transplantation changed. As a result, the priority for liver transplantation is currently based on the Model for End-Stage Liver Disease (MELD) score, which is a whole-number score derived from objective laboratory values. Unfortunately, there are no data regarding outcomes for living donor liver transplant recipients based on MELD score. Based on the poor outcomes in status 2A transplant recipients, we were concerned that high MELD scores would be associated with poor outcomes after LDLT. Therefore, we retrospectively analyzed the short-term outcomes (post-LDLT hospitalization days, 1-year patient and graft survival) in 62 living donor liver transplant recipients relative to MELD scores. Because the MELD score is designed to predict short-term mortality, we believed a high preoperative MELD score may predict greater postoperative morbidity and mortality. Methods PatientsWe retrospectively analyzed all adult living donor liver transplant recipients at the University of Colorado Health Sciences Center in Denver between August 1997 and March 2002. We excluded patients with fulminant hepatic failure. MELD ScoresThe most recent pretransplantation internationalized normalized ratio and bilirubin and creatinine levels were used to calculate a MELD score for each patient. Scores were calcuFrom the *Divisions

Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

“…The performance of the MELD score in predicting posttransplant survival has been more variable (9)(10)(11)(12)(13) but it is generally accepted that patients with very high MELD scores prior to transplant have worse outcomes than those with lower MELDs. With discussion of incorporation of the delta-MELD into organ allocation systems, the question of whether patients with high pretransplant delta-MELD scores have worse posttransplant outcomes would be critical in determining if this change in allocation system would increase posttransplant death rates.…”

Predictive factors of early graft loss in living donor liver transplantation

“…There are few studies correlating pretransplant MELD score with survival after living donor liver transplantation (6,20,33,35) . Hayashi et al (20) found no association between MELD score and patient survival in living donor liver transplantation recipients. However, the MELD scores were low in that study even among patients who died.…”

Recurrence of cholestatic liver disease after living donor liver transplantation

“…There have been sporadic case reports from Asian regions [31][32][33][34] , as well as from the West [35][36][37][38][39] , of LDLT for PSC from living related donors since then, but none reported recurrence; follow-up periods were less than 2 years in most case reports. Aside from the above case reports, cases of LDLT for PSC are found in moderate to large registries worldwide [40][41][42][43][44] . Moon et al [40] reported 2 cases of LDLT for PSC among their large series of 580 LDLTs.…”