Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores

被引:0
作者
Kenneth SH Chok [1 ]
See Ching Chan [1 ,2 ]
James YY Fung [2 ,3 ]
Tan To Cheung [1 ]
Albert CY Chan [1 ]
Sheung Tat Fan [1 ,2 ]
Chung Mau Lo [1 ,2 ]
机构
[1] Department of Surgery,The University of Hong Kong
[2] State Key Laboratory for Liver Research, The University of Hong Kong
[3] Department of Medicine,The University of Hong Kong
关键词
Model for End-stage Liver Disease; living donor liver transplantation; survival; right-lobe;
D O I
暂无
中图分类号
R657.3 [肝及肝管];
学科分类号
1002 ; 100210 ;
摘要
BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score <25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P<0.001), mechanical ventilation (21.3% vs 0%; P<0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P<0.001); more blood was transfused during operation (7 vs 2 units; P<0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P<0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.
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页码:256 / 262
页数:7
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