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

✍ Scribed by Nam-Joon Yi; Kyung-Suk Suh; Hae Won Lee; Woo Young Shin; Juhyun Kim; Won Kim; Yoon Jun Kim; Jung-Hwan Yoon; Hyo-Suk Lee; Kuhn Uk Lee

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 204 KB
• Volume: 15
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21606

✦ Synopsis

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.