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(D+10) MELD as a novel predictor of patient and graft survival after adult to adult living donor liver transplantation
Authors:Arvinder Singh Soin  Sanjay Goja  Sanjay Kumar Yadav  Tseten Yonjen Tamang  Amit Rastogi  Prashant Bhangui  Srinivasan Thiagrajan  Vikram Raut  Raghvendra Y. Babu  Sanjiv Saigal  Neeraj Saraf  Narendra Singh Choudhary  Vijay Vohara
Affiliation:Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta‐The Medicity, Gurgaon, India
Abstract:We modified the previously described D‐MELD score in deceased donor liver transplant, to (D+10)MELD to account for living donors being about 10 years younger than deceased donors, and tested it on living donor liver transplantation (LDLT) recipients. Five hundred consecutive LDLT, between July 2010 and December 2012, were retrospectively analyzed to see the effect of (D+10)MELD on patient and graft survival. Donor age alone did not influence survival. Recipients were divided into six classes based on the (D+10)MELD score: Class 1 (0‐399), Class 2 (400‐799), Class 3 (800‐1199), Class 4 (1200‐1599), Class 5 (1600‐1999), and Class 6 (>2000). The 1 year patient survival (97.1, 88.8, 87.6, 76.9, and 75% across Class 1‐5, P=.03) and graft survival (97.1, 87.9, 82.3, 76.9, and 75%; P=.04) was significantly different among the classes. The study population was divided into two groups at (D+10)MELD cut off at 860. Group 1 had a significantly better 1 year patient (90.4% vs 83.4%; P=.02) and graft survival (88.6% vs 80.2%; P=.01). While donor age alone does not predict recipient outcome, (D+10)MELD score is a strong predictor of recipient and graft survival, and may help in better recipient/donor selection and matching in LDLT.
Keywords:cirrhosis  donor  liver     MELD     transplantation
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