title: A high MELD score, combined with the presence of hepatitis C, is associated with a poor prognosis in living donor liver transplantation.
abstract: OBJECTIVE
  The feasibility of performing living donor liver transplantation (LDLT) for patients with high end-stage liver disease (MELD) scores needs to be assessed.
  
  
  METHODS
  A total of 357 patients who underwent LDLT were included in this analysis.
  
  
  RESULTS
  Overall, 46 patients had high MELD scores (≥ 25) and their graft survival was similar to that in patients with low MELD scores (<25; n = 311; p = 0.395). However, among patients with high MELD scores, a multivariate analysis showed that the presence of hepatitis C (p = 0.013) and LDLT in Era-I (p = 0.036) was significantly associated with a poorer prognosis. Among patients with hepatitis C (n = 155), the 5-year graft survival rate was significantly lower in patients with high MELD scores (33.7 %, p < 0.001) than in patients with low MELD scores. The 5-year graft survival rate was significantly lower in patients in Era-I (n = 119) compared with those in Era-II/III when stratified by low (73.0 vs. 82.5 %, p = 0.040) and high (55.0 vs. 86.1 %, p = 0.023) MELD scores. Among the patients with high MELD scores, those with hepatitis C and LDLT in Era-I had the worst 5-year graft survival rate (14.3, p < 0.001).
  
  
  CONCLUSIONS
  The graft outcomes in patients with high MELD scores and the presence of hepatitis C were found to be particularly poor.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan, tikesurg@yahoo.co.jp.
authors: Toru
authors: T
authors: Ikegami
authors: Ken
authors: K
authors: Shirabe
authors: Shohei
authors: S
authors: Yoshiya
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Yo-Ichi
authors: Y
authors: Yamashita
authors: Norifumi
authors: N
authors: Harimoto
authors: Takeo
authors: T
authors: Toshima
authors: Hideaki
authors: H
authors: Uchiyama
authors: Yuji
authors: Y
authors: Soejima
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome