Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft. Liver Transpl 2009 May;15(5):496-503
Date
04/29/2009Pubmed ID
19399732DOI
10.1002/lt.21606Scopus ID
2-s2.0-67649975639 (requires institutional sign-in at Scopus site) 62 CitationsAbstract
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.
Author List
Yi NJ, Suh KS, Lee HW, Shin WY, Kim J, Kim W, Kim YJ, Yoon JH, Lee HS, Lee KUAuthor
Joohyun Kim MD, PhD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Carcinoma, Hepatocellular
Female
Graft Rejection
Graft Survival
Hepatitis B
Hospital Mortality
Humans
Kaplan-Meier Estimate
Korea
Liver
Liver Cirrhosis
Liver Neoplasms
Liver Transplantation
Living Donors
Male
Middle Aged
Organ Size
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Severity of Illness Index
Time Factors
Treatment Outcome
Young Adult
