Outcomes of hemi- versus whole liver transplantation in patients from mainland china with high model for end-stage liver disease scores: a matched analysis

Abstract

Background Adult hemiliver transplantation (AHLT) is an important approach given the current shortage of donor livers. However, the suitability of AHLT versus adult whole liver transplantation (AWLT) for recipients with high Model for End-Stage Liver Disease (MELD) scores remains controversial. Methods We divided patients undergoing AHLT and AWLT into subgroups according to their MELD scores (≥ 30: AHLT, n = 35; AWLT, n = 88; and < 30: AHLT, n = 323; AWLT, n = 323). Patients were matched by demographic data and perioperative conditions according to propensity scores. A cut-off value of 30 for MELD scores was determined by comparing the overall survival data of 735 cases of nontumor liver transplantation. Results Among patients with an MELD score ≥ 30 and < 30, AHLT was found to be associated with increased warm ischemia time, operative time, hospitalization time, and intraoperative blood loss compared with AWLT (P < 0.05). In the MELD ≥ 30 group, although the 5-year survival rate was significantly higher for AWLT than for AHLT (P = 0.037), there was no significant difference between AWLT and AHLT in the MELD < 30 group (P = 0.832); however, we did not observe a significant increase in specific complications following AHLT among patients with a high MELD score (≥ 30). Among these patients, the incidence of complications classified as Clavien-Dindo grade III or above was significantly higher in patients undergoing AHLT than in those undergoing AWLT (25.7% vs. 11.4%, P = 0.047). For the MELD < 30 group, there was no significant difference in the incidence of complications classified as Clavien-Dindo grade III or above for patients undergoing AHLT or AWLT. Conclusion In patients with an MELD score < 30, AHLT can achieve rates of mortality and overall survival comparable to AWLT. In those with an MELD score ≥ 30, the prognosis and incidence of complications classified as Clavien-Dindo III or above are significantly worse for AHLT than for AWLT; therefore, we may need to be more cautious regarding the conclusion that patients with a high MELD score can safely undergo AHLT.

Deceased by Brain Death Liver Transplant vs. Living Donor Transplant/Putting Deceased Donor on Pump

“…In MELD score > 30, the 5-year survival year in the AWHLT group was significantly higher. However, there was no significant difference between survival outcomes in patients with MELD scores less than 30 [40].…”

MELD Skoru Yüksek Canlı Vericili Karaciğer Nakli Alıcılarında Perioperatif Bulgular ve Postoperatif Komplikasyonlar

“…Cold ischemia time (p = 0.046) was statistically longer in patients with MELD >20 (Table 2). There was no statistically significant difference between those with MELD >20, and MELD As the MELD score increases, the need for perioperative blood transfusion increases (1,6) and the duration of surgery increases (1,5,8,9). Considering the perioperative findings that the anhepatic phase and cold ischemia time increase with increasing The mean anhepatic phase duration was 89.5 minutes, and the mean cold ischemia time was 68.6 minutes.…”

“…Additionally, statistical studies conducted with a higher number of patients in recipients with a much higher MELD score may change the course of the findings. The strength of the MELD (6,7,9). However, we should not ignore the studies showing that the perioperative findings we mentioned above have no relationship with MELD, among the heterogeneous results (6,8,10).…”

Application of various surgical techniques in liver transplantation: a retrospective study

“…Many factors play an important role in the outcome of LT and technique-related factors, including operative duration, intraoperative bleeding, and complications, are the most important. In China, majority of patients are complicated with portal hypertension, causing extensive collateral circulation between the PV and vena cava (16,17). Therefore, hemodynamic instability, such as bleeding during the operation, higher PV pressure during the anhepatic period and lower peripheral vascular resistance, more commonly occur and affect the success of the operation and posttransplant survival.…”