In Light of a New Transplant Allocation Policy, Is a LDLT Program Still Justified in a High MELD Region?

Abstract

Introduction: Living donor liver transplant (LDLT) has a unique role in providing life-saving organs for patients who do not have access to the deceased donor pool. The new liver allocation system expands availability of the national resource of donated organs to reduce waitlist mortality. Aim: To evaluate our LDLT program under the new allocation system and its justification in a high MELD region. Methods: We retrospectively reviewed outcomes of deceased donor LT (DDLT) and LDLT at our institution before (01/2018-01/2020) and after (02/2020-07/2021) allocation change. Results. A total of 247 transplants were included. The median OLTX MELD pre-allocation was 34 and 33 post-allocation. LDLT recipients had a non-significant decrease in MELD from 17 to 14. Only 4% of DDLT recipients were transplanted at a MELD within the LDLT IQR of 9-18 over both periods. The waiting time (WT) for DDLT pre-allocation was a median of 66 days (IQR 253) vs. 11 (213) (p=0.012) post. The WT for hepatocellular carcinoma (HCC) patients increased from 310 to 344 days after allocation change and the proportion of HCC transplants decreased from 28% to 13% (p=0.008) Discussion: Despite the positive impact of the allocation system on high MELD patients, lower MELD and HCC candidates seem to have less access to DDLT. In our institution, where a high MELD score at transplant is common, LDLT is an important option for these patients due to organ shortages.