title: Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft.
abstract: 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.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Shin
authors.forename: Juhyun
authors.initials: J
authors.lastname: Kim
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications* / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea / Q000453:epidemiology; D008099:Liver / Q000601:surgery*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult