Benefit of living donor liver transplantation

Benefit of living donor liver transplantation according to MELD score and diagnosis of hepatocellular carcinoma.

Reported by Jules Levn
in
AASLD Oct 31-Nov 3 2009, Boston

C. L. Berg1; R. M. Merion2; T. H. Shearon3; K. M. Olthoff4; R. S. Brown5; T. B. Baker6; G. T. Everson7; J. C. Hong8; N. Terrault9; P. H. Hayashi10; R. A. Fisher11; J. E. Everhart12

1. Department of Medicine, University of Virginia, Charlottesville, VA, USA.

2. Department of Surgery, University of Michigan, Ann Arbor, MI, USA.

3. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.

4. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.

5. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.

6. Department of Surgery, Northwestern University, Chicago, IL, USA.

7. Department of Medicine, University of Colorado, Aurora, CO, USA.

8. Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.

9. Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

10. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.

11. Department of Surgery, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA, USA.

12. Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.




Receipt of a living donor liver transplant (LDLT) has been associated with improved survival in comparison to waiting for DDLT. Receipt of DDLT at MELD <15 has not been associated with short-term survival benefit. It is uncertain if survival benefit is accrued by LDLT recipients who present with MELD scores <15.

Aims: To determine if LT candidates in the MELD allocation era with MELD <15 gain a survival benefit by receipt of LDLT as opposed to waiting for DDLT.

Methods: 752 adult pts with chronic liver disease enrolled in the A2ALL study had a potential living donor evaluated 2/28/02 to 3/31/09. We compared the mortality of LDLT recipients from the time of their first donor?s evaluation to mortality of pts who remained on the waiting list or received DDLT (no LDLT group) according to MELD score (<15 or 15+) and diagnosis of HCC.

Results: Of 752 potential LDLT recipients, 394 had MELD <15 and 358 had MELD 15+ at entry. Median follow-up was 911 days (range 4-2560). 327 received LDLT, 235 received DDLT, 47 died without transplant, and 143 were alive without transplant at last follow-up. Among all patients, those receiving LDLT had improved survival over those that did not receive LDLT (HR=0.41, 95% CI 0.27-0.64), confirming previous findings. For patients with MELD <15 (Table), a survival advantage was seen in those patients without HCC but not for those with HCC. For pts with MELD15+, a survival advantage was associated with receipt of LDLT for pts both with and without HCC.

Conclusions: In the MELD liver allocation era, pts without HCC and MELD <15 derived a significant survival benefit when undergoing LDLT rather than waiting for DDLT. Even greater survival advantage was observed in pts with MELD 15+, confirming that the improved survival with LDLT has persisted under the MELD liver allocation system