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Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft.
Liver Transpl 2009; 15(5):496-503LT

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 (>25) and a small-for-size graft (SFSG<0.8% of graft-to-recipient 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 = 105) or Group H (high MELD score, n = 62). To analyze the risk of the graft size, the patients were further stratified as follows: Group Hs (high MELD score and SFSG, n = 11), Hn (high MELD score and normal size graft, n = 51), Ls (low MELD score and SFSG, n = 18), and Ln (low MELD score and normal size graft, n = 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 < 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 > 0.05). 1-YSR was similar among Group Hs (72.7%), Hn (86.3%), Ls (83.3%), and Ln (88.5%) groups (p = 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 = 0.847), and among Group Hs (80.0%), Hn (94.7%), Ls (72.7%), and Ln (96.7%) (p = 0.072). In conclusion, high MELD score (>25) 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.

Authors+Show Affiliations

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19399732

Citation

Yi, Nam-Joon, et al. "Improved Outcome of Adult Recipients With a High Model for End-stage Liver Disease Score and a Small-for-size Graft." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 15, no. 5, 2009, pp. 496-503.
Yi NJ, Suh KS, Lee HW, et al. Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft. Liver Transpl. 2009;15(5):496-503.
Yi, N. J., Suh, K. S., Lee, H. W., Shin, W. Y., Kim, J., Kim, W., ... Lee, K. U. (2009). Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 15(5), pp. 496-503. doi:10.1002/lt.21606.
Yi NJ, et al. Improved Outcome of Adult Recipients With a High Model for End-stage Liver Disease Score and a Small-for-size Graft. Liver Transpl. 2009;15(5):496-503. PubMed PMID: 19399732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft. AU - Yi,Nam-Joon, AU - Suh,Kyung-Suk, AU - Lee,Hae Won, AU - Shin,Woo Young, AU - Kim,Juhyun, AU - Kim,Won, AU - Kim,Yoon Jun, AU - Yoon,Jung-Hwan, AU - Lee,Hyo-Suk, AU - Lee,Kuhn Uk, PY - 2009/4/29/entrez PY - 2009/4/29/pubmed PY - 2009/7/10/medline SP - 496 EP - 503 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 15 IS - 5 N2 - 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 (>25) and a small-for-size graft (SFSG<0.8% of graft-to-recipient 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 = 105) or Group H (high MELD score, n = 62). To analyze the risk of the graft size, the patients were further stratified as follows: Group Hs (high MELD score and SFSG, n = 11), Hn (high MELD score and normal size graft, n = 51), Ls (low MELD score and SFSG, n = 18), and Ln (low MELD score and normal size graft, n = 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 < 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 > 0.05). 1-YSR was similar among Group Hs (72.7%), Hn (86.3%), Ls (83.3%), and Ln (88.5%) groups (p = 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 = 0.847), and among Group Hs (80.0%), Hn (94.7%), Ls (72.7%), and Ln (96.7%) (p = 0.072). In conclusion, high MELD score (>25) 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. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/19399732/Improved_outcome_of_adult_recipients_with_a_high_model_for_end_stage_liver_disease_score_and_a_small_for_size_graft_ L2 - https://doi.org/10.1002/lt.21606 DB - PRIME DP - Unbound Medicine ER -