title: Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients.
abstract: Although living donor liver transplantation (LDLT) is a successful procedure for most recipients, outcomes in patients who undergo transplantation as United Network for Organ Sharing status 2A are marginal. There are no published data on living donor liver transplant recipient outcomes relative to Model for End-Stage Liver Disease (MELD) scores. Such information could be useful in living donor liver transplant recipient selection. We retrospectively analyzed all non-fulminant hepatic failure, right hepatic lobe, adult-to-adult living donor liver transplant recipients at our center between August 1997 and March 2002. We calculated MELD scores at the time of LDLT and correlated scores with 1-year patient and graft survival and hospital days during the 90-day post-LDLT period. There were 62 recipients with greater than 6 months of follow-up: 38 men, 24 women; mean age, 47.9 years; 42 white, 1 black, 17 Hispanic, and 2 Asian patients. Twenty-nine patients had hepatitis C virus infection; 4 patients, hepatitis C virus infection and alcoholic liver disease; 4 patients, alcoholic liver disease; 4 patients, cryptogenic cirrhosis; 13 patients, primary sclerosing cholangitis; 5 patients, autoimmune hepatitis; and 3 patients, primary biliary cirrhosis. Mean and median MELD scores were 15.2 and 13, respectively (range, 6 to 40). One-year patient and graft survival were 59 of 62 patients (95%) and 52 of 62 patients (84%), respectively. There was no statistically significant difference between median MELD scores of dead versus living patients (15 v 13; P =.15) or patients who underwent retransplantation versus those who did not (16.5 v 13; P =.30). Mean and median hospital days in the 90-day post-LDLT period were 23.7 and 16.0 days, respectively. Living donor liver transplant recipients with a MELD score of 18 or greater had significantly more hospital days compared with recipients with a MELD score less than 18 (35.2 v 19.8 days; P =.01). In conclusion, MELD scores did not predict post-LDLT patient or graft survival at 1 year. However, higher MELD scores (> or =18) were associated with more hospital days during the 3-month post-LDLT period.
authors.affiliation: Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver 80262, USA.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Hayashi
authors.forename: Lisa
authors.initials: L
authors.lastname: Forman
authors.forename: Tracy
authors.initials: T
authors.lastname: Steinberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Bak
authors.forename: Michael
authors.initials: M
authors.lastname: Wachs
authors.forename: Marcelo
authors.initials: M
authors.lastname: Kugelmas
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Everson
authors.forename: Igal
authors.initials: I
authors.lastname: Kam
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
mesh_terms: D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome