Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft

Abstract

Although adult-to-adult living donor liver transplantation (ALDLT) has shown comparable outcomes to deceased donor liver transplantation, the outcome of patients with a high MELD score (Ͼ25) and a small-for-size graft (SFSGϽ0.8% of graft-torecipient weight ratio) is not known. For 7 years, 167 consecutive hepatitis B virus-infected recipients underwent ALDLT at our institution. Based on their MELD score without additional score for hepatocellular carcinoma (HCC), the recipients were divided into Group L (low MELD score, n ϭ 105) or Group H (high MELD score, n ϭ 62). To analyze the risk of the graft size, the patients were further stratified as follows: Group Hs (high MELD score and SFSG, n ϭ 11), Hn (high MELD score and normal size graft, n ϭ 51), Ls (low MELD score and SFSG, n ϭ 18), and Ln (low MELD score and normal size graft, n ϭ 87). The primary endpoint was one-year patient survival rate (1-YSR). The mean follow-up period was 32.6 months. The mean MELD scores were 17.1 in Group L and 32.6 in Group H. Group H had more patients with the complications of cirrhosis but less patients with HCC than Group L (p Ͻ 0.05). However, major morbidity rates and 1-YSR were similar in comparisons between Group L (46.7% and 86.7%) and H (59.7% and 83.8%) (p Ͼ 0.05). 1-YSR was similar among Group Hs (72.7%), Hn (86.3%), Ls (83.3%), and Ln (88.5%) groups (p ϭ 0.278). The multivariate analysis revealed accompanying HCC and the year of transplant were risk factors for poor 1-YSR. However, 1-YSR without HCC patients was also similar in comparisons between group L (90.2%) and H (91.7%) (p ϭ 0.847), and among Group Hs (80.0%), Hn (94.7%), Ls (72.7%), and Ln (96.7%) (p ϭ 0.072). In conclusion, high MELD score (Ͼ25) didn't predict 1-YSR in ALDLT. Improvement of the 1-YSR might be affected by center's experience as well as the selection of patients with low risk of recurrence of HCC. Liver Transpl 15:496-503, 2009.

The Impact of Treated Bacterial Infections within One Month before Living Donor Liver Transplantation in Adults

“…The same result was also reported in LDLT [8,9]. However, other studies have concluded that the MELD score had no correlation with graft or patient survival [10][11][12]. We found that a MELD score >20 was associated with a lower one-year survival rate.…”

Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia

“…We consider that SFSS after LDLT is included in the concept of PGD after LDLT, because functional graft dysfunction after LDLT is now thought to be caused by graft size as well as several other factors (11)(12)(13)(14)(15). In this analysis, such additional factors included Child class C, MELD score >15, prolonged pretransplant hospi- talized status, the presence of major shunt vessels, donor age >45 years, PVP >20 mmHg at the end of the surgery and intraoperative blood loss >10 L. Although small-forsize graft dysfunction was originally defined in 2005 (8) and has been used in many reports published since then, the descriptions better resemble PNF in DDLT, namely severe coagulopathy (PT-INR >2) and advanced encephalopathy (Grade 3 or 4) with T.Bil >100 lmol/L during the first postoperative week.…”

“…Nevertheless, transplantation centers are also considering smaller grafts, with improved outcomes under refined and established surgical techniques (11)(12)(13)(14). Indeed, recent studies have documented that small grafts do not necessarily cause or correspond to PGD, which is attributed to multiple factors including disease severity, portal pressure, graft regeneration and donor age (15).…”

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“…The recipient's condition is an important variable because a larger graft volume may be necessary when the recipient's peritransplant liver function is severely impaired. [29][30][31][32] In the present study, recipients selected to receive small-for-size grafts had low median Model for End-Stage Liver Disease and Child-Turcotte-Pugh score (Table 1) to ensure good outcomes with small-for-size grafts.…”