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. 2023 Nov 1;109(11):3459-3466.
doi: 10.1097/JS9.0000000000000634.

Survival benefit of living-donor liver transplantation in patients with a model for end-stage liver disease over 30 in a region with severe organ shortage: a retrospective cohort study

Seung Hyuk Yim  1 , Deok Gie Kim, Minyu Kang, Hwa Hee Koh, Mun Chae Choi, Eun Ki Min, Jae Geun Lee, Myoung Soo Kim, Dong Jin Joo
Affiliations

Survival benefit of living-donor liver transplantation in patients with a model for end-stage liver disease over 30 in a region with severe organ shortage: a retrospective cohort study

Seung Hyuk Yim et al. Int J Surg. .

Abstract

Background: The benefits of living-donor liver transplantation (LDLT) in patients with a high Model for End-stage Liver Disease (MELD) score (who have high waitlist mortality) are unclear. Regional availability of deceased-donor organs must be considered when evaluating LDLT benefits. The authors aimed to compare the survival benefit of intended-LDLT to awaiting deceased-donor liver transplantation (DDLT) in patients with a MELD score greater than or equal to 30 in a region with severe organ shortage.

Materials and methods: This retrospective review included 649 patients with a MELD score greater than or equal to 30 placed on the liver transplantation waitlist. They were divided into intended-LDLT ( n =205) or waiting-DDLT ( n =444) groups based on living-donor eligibility and compared for patient survival from the time of waitlisting. Post-transplantation outcomes of transplant recipients and living donors were analyzed.

Results: Intended-LDLT patients had higher 1-year survival than waiting-DDLT patients (53.7 vs. 28.8%, P <0.001). LDLT was independently associated with lower mortality [hazard ratio (HR), 0.62; 95% CI, 0.48-0.79; P <0.001]. During follow-up, 25 patients were de-listed, 120 underwent LDLT, 170 underwent DDLT, and 334 remained on the waitlist. Among patients undergoing transplantation, the risk of post-transplantation mortality was similar for LDLT and DDLT after adjusting for pretransplantation MELD score (HR, 1.86; 95% CI, 0.73-4.75; P =0.193), despite increased surgical complications after LDLT (33.1 vs. 19.4%, P =0.013). There was no mortality among living-donors, but 4.2% experienced complications of grade 3 or higher.

Conclusions: Compared to awaiting DDLT, LDLT offers survival benefits for patients with a MELD score greater than or equal to 30, while maintaining acceptable donor outcomes. LDLT is a feasible treatment for patients with a MELD score greater than or equal to 30 in regions with severe organ shortages.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Study flowchart. DDLT, deceased-donor liver transplantation; HCC, hepatocellular carcinoma; LDLT, living-donor liver transplantation; LT, liver transplantation; MELD, Model for End-stage Liver Disease.
Figure 2
Figure 2
Comparison of survival curves after waitlisting for the Intended-LDLT versus Waiting-DDLT groups of patients with a MELD score greater than or equal to 30. DDLT, deceased-donor liver transplantation; LDLT, living-donor liver transplantation; MELD, Model for End-stage Liver Disease.
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References

    1. Lee SG. A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients. Am J Transplant 2015;15:17–38. - PubMed
    1. Goldaracena N, Barbas AS. Living donor liver transplantation. Curr Opin Organ Transplant 2019;24:131–137. - PubMed
    1. Li MT, Hillyer GC, Husain SA, et al. . Cultural barriers to organ donation among Chinese and Korean individuals in the United States: a systematic review. Transpl Int 2019;32:1001–1018. - PMC - PubMed
    1. Jesse MT, Jackson WE, Liapakis A, et al. . Living donor liver transplant candidate and donor selection and engagement: meeting report from the living donor liver transplant consensus conference. Clin Transplant 2023;37:e14954. - PubMed
    1. Ikegami T, Yoshizumi T, Ohira M, et al. . Indication of living donor liver transplantation for septuagenarians from double equipoise theory. Am J Transplant 2018;18:278–279. - PubMed