Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era. Hepatology 2011 Oct;54(4):1313-21
Date
06/21/2011Pubmed ID
21688284Pubmed Central ID
PMC3184197DOI
10.1002/hep.24494Scopus ID
2-s2.0-80053330697 (requires institutional sign-in at Scopus site) 122 CitationsAbstract
UNLABELLED: Receipt of a living donor liver transplant (LDLT) has been associated with improved survival compared with waiting for a deceased donor liver transplant (DDLT). However, the survival benefit of liver transplant has been questioned for candidates with Model for Endstage Liver Disease (MELD) scores <15, and the survival advantage of LDLT has not been demonstrated during the MELD allocation era, especially for low MELD patients. Transplant candidates enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study after February 28, 2002 were followed for a median of 4.6 years. Starting at the time of presentation of the first potential living donor, mortality for LDLT recipients was compared to mortality for patients who remained on the waiting list or received DDLT (no LDLT group) according to categories of MELD score (<15 or ≥ 15) and diagnosis of hepatocellular carcinoma (HCC). Of 868 potential LDLT recipients (453 with MELD <15; 415 with MELD ≥ 15 at entry), 712 underwent transplantation (406 LDLT; 306 DDLT), 83 died without transplant, and 73 were alive without transplant at last follow-up. Overall, LDLT recipients had 56% lower mortality (hazard ratio [HR] = 0.44, 95% confidence interval [CI] 0.32-0.60; P < 0.0001). Among candidates without HCC, mortality benefit was seen both with MELD <15 (HR = 0.39; P = 0.0003) and MELD ≥ 15 (HR = 0.42; P = 0.0006). Among candidates with HCC, a benefit of LDLT was not seen for MELD <15 (HR = 0.82, P = 0.65) but was seen for MELD ≥ 15 (HR = 0.29, P = 0.043).
CONCLUSION: Across the range of MELD scores, patients without HCC derived a significant survival benefit when undergoing LDLT rather than waiting for DDLT in the MELD liver allocation era. Low MELD candidates with HCC may not benefit from LDLT.
Author List
Berg CL, Merion RM, Shearon TH, Olthoff KM, Brown RS Jr, Baker TB, Everson GT, Hong JC, Terrault N, Hayashi PH, Fisher RA, Everhart JEMESH terms used to index this publication - Major topics in bold
AdultCarcinoma, Hepatocellular
Cohort Studies
End Stage Liver Disease
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Liver Neoplasms
Liver Transplantation
Living Donors
Male
Middle Aged
Multivariate Analysis
Patient Selection
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Survival Analysis
Tissue and Organ Procurement
Waiting Lists