Benefit of living donor liver transplantation in graft survival for extremely high model for end-stage liver disease score ≥35

Background and Aimsn: Living liver donation with high model for end-stage liver disease (MELD) score was discouraged despite organ shortage. This study aimed to compare graft survival between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) recipients with extremely high-MELD (score of >= 35).Methods: Between 2008 and 2018, 359 patients who underwent liver transplantation with a MELD score >= 35 were enrolled. We compared graft survival between LDLT and DDLT after propensity score matching (PSM) and performed subgroup analysis according to donor type.Results: After PSM, there was no statistical difference in graft survival between the LDLT and DDLT groups (p = .466). Old age, acute on chronic liver failure, re-transplantation, preoperative intensive care unit stay and red blood cell (RBC) transfusion during the operation were risk factors for graft failure (p = .046, .005, .032, .015 and .001, respectively). Biliary complications were more common in the LDLT group (p = .021), while viral infection, postoperative uncontrolled ascites, and postoperative hemodialysis were more common in the DDLT group (p = .002, .018, and .027, respectively). In the LDLT group, acute chronic liver failure, intraoperative RBC transfusion, and early postoperative complications were risk factors for graft failure (p = .007, <.001, and .001, respectively).Conclusion: Our study showed that LDLT is not inferior to DDLT in graft survival if appropriate risk evaluation is performed in cases of extremely high-MELD scores. This result will help overcome organ shortages in high-MELD liver transplantation.

Automated summary

The study shows that LDLT is comparable to DDLT in terms of graft survival for high-MELD liver transplantation. Biliary complications are more common in LDLT group while viral infection, postoperative uncontrolled ascites, and postoperative hemodialysis are more common in DDLT group. Acute chronic liver failure, intraoperative RBC transfusion, and early postoperative complications are risk factors for graft failure in LDLT group.