Erschienen in:
01.02.2014 | Original Article
A high MELD score, combined with the presence of hepatitis C, is associated with a poor prognosis in living donor liver transplantation
verfasst von:
Toru Ikegami, Ken Shirabe, Shohei Yoshiya, Tomoharu Yoshizumi, Yo-ichi Yamashita, Norifumi Harimoto, Takeo Toshima, Hideaki Uchiyama, Yuji Soejima, Yoshihiko Maehara
Erschienen in:
Surgery Today
|
Ausgabe 2/2014
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Abstract
Purpose
The feasibility of performing living donor liver transplantation (LDLT) for patients with high end-stage liver disease (MELD) scores needs to be assessed.
Methods
A total of 357 patients who underwent LDLT were included in this analysis.
Results
Overall, 46 patients had high MELD scores (≥25) and their graft survival was similar to that in patients with low MELD scores (<25; n = 311; p = 0.395). However, among patients with high MELD scores, a multivariate analysis showed that the presence of hepatitis C (p = 0.013) and LDLT in Era-I (p = 0.036) was significantly associated with a poorer prognosis. Among patients with hepatitis C (n = 155), the 5-year graft survival rate was significantly lower in patients with high MELD scores (33.7 %, p < 0.001) than in patients with low MELD scores. The 5-year graft survival rate was significantly lower in patients in Era-I (n = 119) compared with those in Era-II/III when stratified by low (73.0 vs. 82.5 %, p = 0.040) and high (55.0 vs. 86.1 %, p = 0.023) MELD scores. Among the patients with high MELD scores, those with hepatitis C and LDLT in Era-I had the worst 5-year graft survival rate (14.3, p < 0.001).
Conclusion
The graft outcomes in patients with high MELD scores and the presence of hepatitis C were found to be particularly poor.