Korean J Transplant.  2022 Nov;36(Supple 1):S317. 10.4285/ATW2022.F-4553.

Graft survival according to donor type, and risk assessment in liver transplantation of extremely high model for end-stage liver disease score ≥35

• Yun SO
• Kim JM
• Choi GS
• Joh JW
• Rhu J

• KMID: 2535544
• DOI: http://doi.org/10.4285/ATW2022.F-4553

Abstract

Background
Although organ shortage was still the greatest problem in liver transplantation, living liver donation with high model for end-stage liver disease (MELD) score was discouraged until recently. The purpose of this study was to compare graft survival between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) groups in extremely high MELD recipient defined as score 35 and to evaluate risk factors affecting graft survival.
Methods
Between 2008 and 2018, a total of 359 patients who underwent liver transplantation with MELD score 35 at the Sam-sung Medical Center, were enrolled. The primary endpoint was the graft survival and the secondary endpoint was short term postoperative complication (within 90 days after liver transplantation). Also, we compared the graft survival and overall survival between living and deceased donor and assessed risk factors for graft survival according to the donor type.
Results
There was no statistical difference in graft survival between LDLT and DDLT group (P=0.753). Old age, preoperative management in intensive care unit and RBC transfusion during the operation were the risk factors in graft failure (P=0.032, P=0.036, P=0.001, respectively). Biliary complication was more common in LDLT group (P=0.021), and viral infection and post-operative uncontrolled ascites were more common in DDLT group (P=0.002 and P=0.018). In LDLT group, acute on chronic liver failure, left side graft, retransplantation, postoperative short-term complications, intraoperative transfusion and long cold ischemic time were risk factors in graft failure (P=0.004, P=0.025, P=0.015, P=0.016, P<0.001, and P=0.006, respectively).
Conclusions
In the meantime, LDLT in high MELD score was often avoided, but our study showed LDLT is not inferior to DDLT in graft survival if appropriate risk evaluation was performed even in extremely high MELD score. This result will help overcoming the organ shortage in high MELD liver transplantation.