title: (D+10) MELD as a novel predictor of patient and graft survival after adult to adult living donor liver transplantation.
abstract: We modified the previously described D-MELD score in deceased donor liver transplant, to (D+10)MELD to account for living donors being about 10 years younger than deceased donors, and tested it on living donor liver transplantation (LDLT) recipients. Five hundred consecutive LDLT, between July 2010 and December 2012, were retrospectively analyzed to see the effect of (D+10)MELD on patient and graft survival. Donor age alone did not influence survival. Recipients were divided into six classes based on the (D+10)MELD score: Class 1 (0-399), Class 2 (400-799), Class 3 (800-1199), Class 4 (1200-1599), Class 5 (1600-1999), and Class 6 (>2000). The 1 year patient survival (97.1, 88.8, 87.6, 76.9, and 75% across Class 1-5, P=.03) and graft survival (97.1, 87.9, 82.3, 76.9, and 75%; P=.04) was significantly different among the classes. The study population was divided into two groups at (D+10)MELD cut off at 860. Group 1 had a significantly better 1 year patient (90.4% vs 83.4%; P=.02) and graft survival (88.6% vs 80.2%; P=.01). While donor age alone does not predict recipient outcome, (D+10)MELD score is a strong predictor of recipient and graft survival, and may help in better recipient/donor selection and matching in LDLT.
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Arvinder Singh
authors.initials: AS
authors.lastname: Soin
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Goja
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Sanjay Kumar
authors.identifier: 0000-0001-8998-9633
authors.initials: SK
authors.lastname: Yadav
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Tseten Yonjen
authors.initials: TY
authors.lastname: Tamang
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhangui
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Thiagrajan
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Raut
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Raghvendra Y
authors.initials: RY
authors.lastname: Babu
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Saigal
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Saraf
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Narendra Singh
authors.identifier: 0000-0002-4387-0036
authors.initials: NS
authors.lastname: Choudhary
authors.affiliation: Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Vohara
mesh_terms: D000328:Adult; D000367:Age Factors; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 
  MELD
  ; cirrhosis; donor; liver; transplantation