Clinical Outcomes of Adult Living Donor Liver Transplantation in High MELD Recipients: A Systematic Review and Meta-Analysis

Abstract

Introduction: There is a clear survival advantage of living donor liver transplantation (LDLT) over waiting for deceased donor liver transplantation (DDLT) for patients with low Model for End-Stage Liver Disease (MELD) score. Results from several centers suggest that the outcomes following LDLT in patients with high-MELD(HM) and low-MELD(LM) are comparable. The aim of study was to verify this observation by performing a meta-analysis of available literature to determine patient survival and graft survival and postoperative outcomes. Methods: Following PROSPERO registration CRD-42021261501, a systematic database search was conducted for literature published between 1990-2021. Ten studies with 2,183 LDLT recipients were identified (N=490 HM group and N=1,693 LM group) and meta-analysis was performed using RevMan 5.3 and STATA/SE-16. Results: Patients in the HM group had comparable mortality at 1, 3 and 5 years post-transplant compared to patients LM group (5-year Hazard Ratio(HR)1.19; 95%CI 0.79-1.79; P-value 0.40). Graft survival was also comparable (5-year HR1.08; 95%CI 0.72-1.63; P-value 0.71.) No statistically significant difference was observed in terms of major morbidity, hepatic artery thrombosis, biliary complications, intraabdominal bleeding, wound infection and rejection. However, HM group had statistically significant higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay(Figure 1, Table 1). Conclusions: HM patients submitted to LDLT had overall comparable survival, graft survival and major morbidity rate compared to LM group despite higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay.Tabled 1FP13-4Table1 Post transplant outcomesA. OutcomesOdds ratio95%CIP-valueI2 (%)Major morbidity1.530.92-2.540.10$41%Hepatic artery thrombosis1.180.52-2.670.70$0%Biliary complications1.060.72-1.570.75$14%Wound infections1.460.51-4.240.48$0%Intraabdominal bleeding1.870.98-3.540.06$0%Pulmonary infections2.071.05-4.080.04**40%Abdominal fluid collections2.261.21-4.240.01**0%B. OutcomesMean difference95%CIP-valueI2 (%)Length of ICU stay1.140.43-1.840.00∗∗29%Strength: I2 --Mild to moderate heterogeneity, $: non-significant difference or comparable outcomes, *: significant difference Open table in a new tab Strength: I2 --Mild to moderate heterogeneity, $: non-significant difference or comparable outcomes, *: significant difference