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Live donor liver transplantation in high MELD score recipients
Markus Selzner1, Arash Kashfi, Mark S Cattral
1Multiorgan Transplant Program, Department of General Surgery, Toronto General Hospital, Toronto, ON.
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.
Insights
Living donor liver transplants are safe and effective for patients with high Model for End-stage Liver Disease (MELD) scores, showing comparable survival rates to those with lower scores. This challenges previous restrictions on liver donation for sicker patients.
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Donation
Background:
- A 2002 guideline restricted live liver donation for recipients with Model for End-stage Liver Disease (MELD) scores above 25.
- This restriction persists despite limited evidence, leading to reluctance in offering living donor (LD) liver transplants to patients with moderate to high MELD scores.
Purpose of the Study:
- To evaluate the outcomes of adult-to-adult right lobe living donor liver transplantation in recipients with high MELD scores (≥25) compared to those with low MELD scores (<25).
Main Methods:
- Retrospective analysis of 271 adult-to-adult right lobe LD liver transplants performed between 2002 and 2008.
- Comparison of short-term outcomes (donor morbidity, graft loss, hospital stay, biochemical markers, post-transplant complications) and long-term outcomes (graft and patient survival at 1, 3, and 5 years) between low and high MELD groups.
Main Results:
- Donor and recipient characteristics were similar between groups, with comparable donor outcomes.
- High MELD recipients experienced more postoperative pneumonia but similar rates of biliary complications, rejection, renal failure, and overall infections.
- Graft survival rates at 1, 3, and 5 years were similar for both low MELD (92%, 86%, 78%) and high MELD (83%, 80%, 80%) recipients.
Conclusions:
- Living donor liver transplantation offers excellent graft function and survival rates, even for recipients with high MELD scores.
- A high MELD score should not be an absolute contraindication for living liver donation, especially when deceased donor organs are scarce.
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