Comparison of 5-year Survival of Living vs Deceased Donor Liver Transplant based on MELD Score at Transplantation

Abstract

Background: Liver transplantation remains the most effective treatment for end stage liver disease and selected primary malignancies. With increasing numbers of patients on the waitlist and growing organ shortage, US transplant centers are increasingly looking toward living donor liver transplantation (LDLT). Single center and meta-regression analysis have shown that LDLT have superior patient survival over deceased donor liver transplantation (DDLT). The aim of this study was to assess whether the survival of recipient of LDLT was superior to DDLT after adjusting for the MELD. Methods: Data was obtained from the SRTR between January 1st 2002 and December 31st 2018. We included 90,046 patients who were ≥18 years who had at least one year of follow-up. Patients were excluded if they had multivisceral or previous Tx or cold ischemia time ≥ 24h. LDLT and DDLT were stratified based on MELD score at transplantation. Kaplan-Meier survival analysis and multivariable cox regression were performed. Results: DDLT were 86,654 (96.2%) and LDLT were 3,392 (3.8%) respectively. The mean MELD for patients who underwent DDLT was 21.3 +/- 9.9 vs LDLT 14.9 +/- 5.5 (p<0.001). Kaplan-Meier survival analysis showed that LDLT patients had overall improved survival compared to DDLT (p<0.001). However, following stratification by MELD score, there was no survival benefit at a MELD>23. Multivariable cox-regression showed that DDLT patients with a MELD score >26 had significant improved survival compared to LDLT (Figure 1). Conclusion: Following adjustment, patients with higher MELD scores (>26) had a higher 5-year survival compared to patients undergoing LDLT.