High MELD score not linked to worse survival for living donor liver transplant recipients
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WASHINGTON — Patient survival was no different for living donor liver transplant recipients with a MELD score greater than 25 compared with those with lower MELD scores, according to data presented at The Liver Meeting.
“Historically, in the United States especially, living donor transplantation has been offered to patients with low or moderate MELD,” Benjamin E. Rosenthal, MD, from the division of gastroenterology and hepatology at University of Pennsylvania, told attendees. “Early studies done from the A2ALL study have shown that living donor transplantation offered a survival benefit vs. remaining on the waitlist independent of MELD score. [However], the outcome of living donor transplantation in the high-MELD setting is currently unknown.”
To determine outcomes of living donor liver transplantation (LDLT) among patients with advanced native MELD score, Rosenthal and colleagues conducted a retrospective study of transplant recipients from Jan. 1, 2010, to December 31, 2021, using data from the Organ Procurement and Transplantation Network. The researchers applied multivariable Cox regression to assess the association of LDLT, compared with deceased donor liver transplantation, for patient and graft survival among recipients with a MELD score greater than 25 at transplant from 2010 to 2021.
According to study results, of the 3,590 LDLTs performed, 342 recipients had native MELD scores greater than 25 at transplant. The researchers observed that adjusted patient survival was no different among LDLT recipients with a MELD score greater than 25 vs. those with a MELD score less than 25 (HR = 1.22; P = .248), with adjusted graft survival also similar between the groups (HR = 1.24; P = .132).
Similarly, when comparing living donor recipients with a MELD score greater than 25 with deceased donor recipients, the researchers reported no difference in unadjusted patient survival (P = .774) or unadjusted graft survival (P = .226).
However, the researchers did note that the retransplant rate was higher among LDLT recipients (5.7%) vs. deceased donor transplant recipients (2.4%). Additionally, adjusted graft survival was worse with LDLT vs. deceased donor transplantation in recipients with a MELD score greater than 25 (HR = 1.36; P = .019).
“The MELD score greater than 25 is not clearly associated with worse survival compared to lower MELD score among living donor transplants,” Rosenthal said. “The survival advantages that have been studied at low MELD populations may in fact be lost in the high MELD setting. Additionally, in those patients with high MELD scores, the graft survival may be worse compared to a deceased donor transplantation.”
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Rosenthal BE, et al. Abstract 59: Characteristics and outcomes of living donor liver transplantation in patients with native model for end-stage liver disease ≥25 in the current era. Presented at: The Liver Meeting; Nov. 4-8, 2022; Washington (hybrid).
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