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Live donor liver transplantation in high MELD score recipients.
Ann Surg. 2010 Jan; 251(1):153-7.AnnS

Abstract

BACKGROUND

In 2002, the New York State Committee on Quality Improvement in Living Liver Donation prohibited live liver donation for potential recipients with Model for End-stage Liver Disease (MELD) scores greater than 25. Despite the paucity of evidence to support this recommendation, many centers in North America remain reluctant to offer living donor (LD) to patients with moderate to high MELD scores.

METHODS

We analyzed 271 consecutive adult-to-adult right lobe LD liver transplants performed at our institution between 2002 and 2008 to study the relationship, between recipient MELD scores and the outcome of LD liver transplantation. The recipients were categorized according to their MELD score into a low (Low: <25)and high (Hi: >or=25) MELD group. We compared short-term donor morbidity, graft loss within 30 days, length of hospital stay, biochemical markers of hepatocyte injury and graft function, and 90 day posttransplant complications including infection, rejection, bleeding, and renal failure. Long-term posttransplant outcome was measured by graft and patient survival after 1-, 3-, and 5-years.

RESULTS

Donor and recipient characteristics were similar between groups. Donor outcomes were similar in both groups. Peak recipient aspartat aminotransferase, alanine aminotransferase, and length of hospital stay were similar between both groups. The proportional decrease in postoperative INR and creatinine within the first week was greater in the high versus low MELD score group. High MELD score recipients had more frequent postoperative pneumonia (Low: 2.2% vs. Hi: 14%, P = 0.003), while no differences were observed in rates of biliary complications, rejection, renal failure, or overall infections. Recipients with a MELD <25 versus >or=25 had a similar 1-year (Low: 92% vs. Hi: 83%), 3-year (Low: 86% vs. Hi: 80%), and 5-year (Low: 78% vs. Hi: 80%) graft survival after LD liver transplantation (P = 0.51).

CONCLUSION

LD liver transplantation can provide excellent graft function and survival rates in high MELD score recipients. Thus, when deceased donor organs are scare, a high MELD score alone should not be an absolute contraindication to living liver donation.

Authors+Show Affiliations

Multiorgan Transplant Program, Department of General Surgery, Toronto General Hospital, Toronto, ON.No 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

19858705

Citation

Selzner, Markus, et al. "Live Donor Liver Transplantation in High MELD Score Recipients." Annals of Surgery, vol. 251, no. 1, 2010, pp. 153-7.
Selzner M, Kashfi A, Cattral MS, et al. Live donor liver transplantation in high MELD score recipients. Ann Surg. 2010;251(1):153-7.
Selzner, M., Kashfi, A., Cattral, M. S., Selzner, N., McGilvray, I. D., Greig, P. D., Levy, G. A., Renner, E. L., & Grant, D. R. (2010). Live donor liver transplantation in high MELD score recipients. Annals of Surgery, 251(1), 153-7. https://doi.org/10.1097/SLA.0b013e3181bc9c6a
Selzner M, et al. Live Donor Liver Transplantation in High MELD Score Recipients. Ann Surg. 2010;251(1):153-7. PubMed PMID: 19858705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Live donor liver transplantation in high MELD score recipients. AU - Selzner,Markus, AU - Kashfi,Arash, AU - Cattral,Mark S, AU - Selzner,Nazia, AU - McGilvray,Ian D, AU - Greig,Paul D, AU - Levy,Gary A, AU - Renner,Eberhard L, AU - Grant,David R, PY - 2009/10/28/entrez PY - 2009/10/28/pubmed PY - 2010/1/13/medline SP - 153 EP - 7 JF - Annals of surgery JO - Ann Surg VL - 251 IS - 1 N2 - BACKGROUND: In 2002, the New York State Committee on Quality Improvement in Living Liver Donation prohibited live liver donation for potential recipients with Model for End-stage Liver Disease (MELD) scores greater than 25. Despite the paucity of evidence to support this recommendation, many centers in North America remain reluctant to offer living donor (LD) to patients with moderate to high MELD scores. METHODS: We analyzed 271 consecutive adult-to-adult right lobe LD liver transplants performed at our institution between 2002 and 2008 to study the relationship, between recipient MELD scores and the outcome of LD liver transplantation. The recipients were categorized according to their MELD score into a low (Low: <25)and high (Hi: >or=25) MELD group. We compared short-term donor morbidity, graft loss within 30 days, length of hospital stay, biochemical markers of hepatocyte injury and graft function, and 90 day posttransplant complications including infection, rejection, bleeding, and renal failure. Long-term posttransplant outcome was measured by graft and patient survival after 1-, 3-, and 5-years. RESULTS: Donor and recipient characteristics were similar between groups. Donor outcomes were similar in both groups. Peak recipient aspartat aminotransferase, alanine aminotransferase, and length of hospital stay were similar between both groups. The proportional decrease in postoperative INR and creatinine within the first week was greater in the high versus low MELD score group. High MELD score recipients had more frequent postoperative pneumonia (Low: 2.2% vs. Hi: 14%, P = 0.003), while no differences were observed in rates of biliary complications, rejection, renal failure, or overall infections. Recipients with a MELD <25 versus >or=25 had a similar 1-year (Low: 92% vs. Hi: 83%), 3-year (Low: 86% vs. Hi: 80%), and 5-year (Low: 78% vs. Hi: 80%) graft survival after LD liver transplantation (P = 0.51). CONCLUSION: LD liver transplantation can provide excellent graft function and survival rates in high MELD score recipients. Thus, when deceased donor organs are scare, a high MELD score alone should not be an absolute contraindication to living liver donation. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19858705/Live_donor_liver_transplantation_in_high_MELD_score_recipients_ L2 - https://Insights.ovid.com/pubmed?pmid=19858705 DB - PRIME DP - Unbound Medicine ER -