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Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores ≥35 in a Hepatitis-B Endemic Area

Chok, Kenneth S. H. MBBS, MS; Fung, James Y. Y. BHB, MBChB, MD; Chan, Albert C. Y. MBBS; Dai, Wing Chiu MBBS; Sharr, William W. MBBS; Cheung, Tan To MBBS, MS; Chan, See Ching MBBS, MS, PhD, MD; Lo, Chung Mau MBBS, MS

doi: 10.1097/SLA.0000000000001671
ORIGINAL ARTICLES
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Objective: To evaluate if living donor liver transplantation (LDLT) should be offered to patients with Model for End-stage Liver Disease (MELD) scores ≥35.

Background: No data was available to support LDLT of such patients.

Methods: Data of 672 consecutive adult liver transplant recipients from 2005 to 2014 at our center were reviewed. Patients with MELD scores ≥35 were divided into the deceased donor liver transplantation (DDLT) group and the LDLT group and were compared. Univariate analysis was performed to identify risk factors affecting survival.

Results: The LDLT group (n = 54) had younger (33 yrs vs 50 yrs, P < 0.001) and lighter (56 Kg vs 65 Kg, P = 0.004) donors, lighter grafts (627.5 g vs 1252.5 g, P < 0.001), lower graft-weight-to-recipient-standard-liver-volume rates (51.28% vs 99.76%, P < 0.001), shorter cold ischemic time (106.5 min vs 389 min, P < 0.001), and longer operation time (681.5 min vs 534 min, P < 0.001). The groups were comparable in postoperative complication, hospital mortality, and graft survival and patient survival at one year (88.9% vs 92.5%; 88.9% vs 94.7%), three years (87.0% vs 86.9%; 87.0% vs 88.8%), and five years (84.8% vs 81.8%; 84.8% vs 83.3%). Univariate analysis did not show inferior survival in LDLT recipients.

Conclusions: At centers with experience, the outcomes of LDLT can be comparable with those of DDLT even in patients with MELD scores ≥35. When donor risks and recipient benefits are fully considered and balanced, an MELD score ≥35 should not be a contraindication to LDLT. In Hong Kong, where most waitlisted patients have acute-on-chronic liver failure from hepatitis B, LDLT is a wise alternative to DDLT.

*Department of Surgery, The University of Hong Kong, Hong Kong, China

State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China

Department of Medicine, The University of Hong Kong, Hong Kong, China.

Reprints: Kenneth S. H. Chok, MBBS, MS, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. E-mail: kennethchok@gmail.com.

Grants and other financial support: This study received no grants or other financial support.

Part of the material was presented at The Liver Meeting 2015 by AASLD, 13–17 November 2015, San Francisco, CA.

Disclosure: The authors declare no conflicts of interest.

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