Outcomes in living donor compared to deceased donor primary liver transplant in lower acuity patients with MELD score < 30
Kitajima T, Moonka D, Yeddula S, Collins K, Rizzari M, Yoshida A, Abouljoud MS, and Nagai S. Outcomes in living donor compared to deceased donor primary liver transplant in lower acuity patients with MELD score < 30. Liver Transpl 2021.
While recent studies have reported favorable outcomes in living donor liver transplantation (LDLT), it remains unclear which populations benefit most from LDLT. The aim of this study is to evaluate post-transplant outcomes in LDLT compared to deceased donor liver transplant (DDLT) according to Model for End-Stage Liver Disease (MELD) score categories. Using data from the OPTN/UNOS registry, outcomes were compared between 1,486 LDLT, 13,568 donation after brain death (DBD) DDLT, and 1,171 donation after circulatory death (DCD) DDLT transplanted between 2009 and 2018. Because LDLT for patients with MELD score >30 was rare (1.8% of all LDLT), all patients with scores > 30 were excluded to equalize LDLT and DDLT cohorts. Risk factors for one-year graft loss were determined in LDLT and DDLT, separately. Compared with LDLT, DBD-DDLT had significantly lower risk of 30-day (aHR 0.60, P<0.001) and one-year graft loss (aHR 0.57, P<0.001). The significantly lower risk of graft loss was more prominent in the mid-MELD score category (score 15-29). DCD-DDLT, compared to LDLT, had significantly lower risk of 30-day graft loss, but comparable risk of one-year graft loss regardless of MELD score category. In LDLT, significant ascites was an independent risk factor for graft loss in patients with mid-MELD scores (aHR 1.68, P=0.02), but not in the lower-MELD score group. Risk of one-year graft loss in LDLT patients with ascites who received left liver was significantly higher than either those who received right liver or those without ascites who received left liver
CONCLUSION: In LDLT, combinations of MELD score of 15-29, moderate/severe ascites and use of left liver, are associated with worse outcomes. These findings help calibrate appropriate patient and graft selection in LDLT.
ePub ahead of print