ABSTRACT

Objectives:

Living donor liver transplantation (LDLT) can be performed more frequently due to insufficient cadaver organ donation. In cases where the number of cadaveric organ is not sufficient patients with high MELD-Na score stand out during waiting. In this study, the effect of high MELD-Na score on early postoperative outcome was investigated in LDLT.

Materials and Methods:

In our study, adult patients with a MELD-Na score of ≥25 between January 2015 and December 2021 were evaluated retrospectively. According to the preoperative MELD-Na score calculated after the treatments applied during the preparation period, the patients were divided into two groups as <25 or ≥25 and evaluated for mortality and complications.

Results:

Fourteen of 43 patients with MELD-Na ≥25 were female (32.6%) and 29 were male (67.4%). The mean age was 48.12±11.89 years. The mean MELD-Na score calculated when planning LDLT was 28.93±4.10 and the preoperative MELD-Na score was 23.72±5.9. Plasmapheresis was applied to 20% of patients during the preoperative period. Complications developed in 81.4% of patients. Bleeding (60.5%), surgical bleeding (11.6%) and acute kidney injury (16.3%) were the most common complications. The mortality rate for the 1^st month was 9.3% and the mortality rate for the 3^rd month was 16.3%. Patients with a preoperative MELD-Na score of ≥25 were found to have a higher hyponatremia rate (73.3%), against MELD-Na <25 (26.7%, p<0.002) while postoperative early morbidity and mortality rates were comparable.

Conclusion:

LDLT patients with the high MELD-Na scores often have a chance of preparing period for surgery in elective conditions, so when they are optimized preoperatively, better results may obtained in terms of both early complications and mortality rates.

Keywords: Liver Transplantation, Hyponatremia, Postoperative Complication, Survival

References

Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018-1026.

Leise MD, Kim WR, Kremers WK, et al. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology. 2011;140:1952-1960.

Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transpl. 2005;11:336-343.

Feng S. Living donor liver transplantation in high Model for End-Stage Liver Disease score patients. Liver Transpl. 2017;23:9-21.

Selzner M, Kashfi A, Cattral MS, et al. Live donor liver transplantation in high MELD score recipients. Ann Surg. 2010;251:153-157.

Chok KSh, Chan SC, Fung JY, et al. Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores. Hepatobiliary Pancreat Dis Int. 2013;12:256-262.

Klein KB, Stafinski TD, Menon D. Predicting survival after liver transplantation based on pre-transplant MELD score: a systematic review of the literature. PLoS One. 2013;8:e80661.

Berg CL, Merion RM, Shearon TH, et al. Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era. Hepatology. 2011;54:1313-1321.

Ivanics T, Leonard-Murali S, Mouzaihem H, et al. Extreme hyponatremia as a risk factor for early mortality after liver transplantation in the MELD-sodium era. Transpl Int. 2021;34:2856-2868.

Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91-96.

Sharma P, Schaubel DE, Gong Q, et al. End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates. Hepatology. 2012;55:192-198.

Samuel D, Coilly A. Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation. BMC Med. 2018;16:113.

Moon DB, Lee SG, Kang WH, et al. Adult Living Donor Liver Transplantation for Acute-on-Chronic Liver Failure in High-Model for End-Stage Liver Disease Score Patients. Am J Transplant. 2017;17:1833-1842.

Cholankeril G, Li AA, Dennis BB, et al. Pre-Operative Delta-MELD is an Independent Predictor of Higher Mortality following Liver Transplantation. Sci Rep. 2019;9:8312.

Cholongitas E, Marelli L, Shusang V, et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transpl. 2006;12:1049-1061.

Nagai S, Chau LC, Schilke RE, et al. Effects of Allocating Livers for Transplantation Based on Model for End-Stage Liver Disease-Sodium Scores on Patient Outcomes. Gastroenterology. 2018;155:1451-1462.

Massie AB, Luo X, Alejo JL, et al. Higher Mortality in registrants with sudden model for end-stage liver disease increase: Disadvantaged by the current allocation policy. Liver Transpl. 2015;21:683-689.

Northup PG, Berg CL. Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation. Am J Transplant. 2004;4:1643-1649.

Tang W, Qiu JG, Cai Y, et al. Increased Surgical Complications but Improved Overall Survival with Adult Living Donor Compared to Deceased Donor Liver Transplantation: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:1320830.

Romano TG, Schmidtbauer I, Silva FM, et al. Role of MELD score and serum creatinine as prognostic tools for the development of acute kidney injury after liver transplantation. PLoS One. 2013;8:e64089.

Living Donor Liver Transplantation Early Period Outcomes with the High MELD-Na Scores: Single Center Experience

ABSTRACT

References