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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.
AuthorsNam-Joon Yi, Kyung-Suk Suh, Hae Won Lee, Woo Young Shin, Juhyun Kim, Won Kim, Yoon Jun Kim, Jung-Hwan Yoon, Hyo-Suk Lee, Kuhn Uk Lee
JournalLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 15 Issue 5 Pg. 496-503 (May 2009) ISSN: 1527-6473 [Electronic] United States
PMID19399732 (Publication Type: Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Hepatocellular (diagnosis, mortality, surgery, virology)
  • Female
  • Graft Rejection (etiology, mortality)
  • Graft Survival
  • Hepatitis B (complications, mortality, surgery)
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Korea (epidemiology)
  • Liver (surgery)
  • Liver Cirrhosis (diagnosis, mortality, surgery, virology)
  • Liver Neoplasms (diagnosis, mortality, surgery, virology)
  • Liver Transplantation (adverse effects, mortality)
  • Living Donors
  • Male
  • Middle Aged
  • Organ Size
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • Young Adult

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