title: Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher.
abstract: Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.). We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT.Methods:All U.S. adult LDLT recipients with MELD < 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry. Survival following LDLT was stratified into three MELD categories (MELD < 15 vs. MELD 15-19 vs. MELD 20-24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards models.Results:Overall, 2,258 patients underwent LDLT. Compared to patients with MELD < 15, overall 5-year survival following LDLT was similar among patients with MELD 15-19 (80.9% vs. 80.3%,p= 0.77) and MELD 20-24 (81.2% vs. 80.3%,p= 0.73). When compared to patients with MELD < 15, there was no significant difference in long-term post-LDLT survival among those with MELD 15-19 (HR: 1.11, 95% CI: 0.85-1.45,p= 0.45) and a non-significant trend towards lower survival in patients with MELD 20-24 (HR: 1.28, 95% CI: 0.91-1.81,p= 0.16). Only 14% of LDLTs were performed in patients with MELD 20-24 and the remaining 86% in patients with MELD < 20.Conclusion:LDLT is underutilized in patients with MELD 20 and higher.
authors: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Ryan B
authors: RB
authors: Perumpail
authors: Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA.
authors: Eric R
authors: ER
authors: Yoo
authors: Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center, Memphis, TN, USA.
authors: George
authors: G
authors: Cholankeril
authors: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Lupe
authors: L
authors: Hogan
authors: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Melodie
authors: M
authors: Deis
authors: Division of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, USA.
authors: Waldo C
authors: WC
authors: Concepcion
authors: Division of Surgery, Division of Abdominal Transplantation, Stanford University School of Medicine, Stanford, CA, USA.
authors: C Andrew
authors: CA
authors: Bonham
authors: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
authors: Zobair M
authors: ZM
authors: Younossi
authors: Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital Campus, Oakland, CA, USA.
authors: Robert J
authors: RJ
authors: Wong
authors: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Aijaz
authors: A
authors: Ahmed
keywords: Liver transplantation; Living donors; Model for End-Stage Liver Disease (MELD); Waitlist