Higher graft-to-host ratio may decrease posttransplant mortality in patients with a high MELD score.

The aim of this study was to determine whether scores from the model for end-stage liver disease (MELD) can be used in the preoperative strategic planning of transplantation surgery. We retrospectively analyzed the outcomes of 62 adult liver transplantation patients whose operation was performed at our center between January 2001 and June 2006. All patients had MELD scores between 8 and 35 with an average value of 20. We compared postoperative mortality among patients who had MELD scores higher than 20 as determined by their graft-to-host ratios. We separately grouped the patients whose graft-to-body weight ratio (GBWR) was equal to or lower than 1 and whose GBWR was higher than 1. The GBWRs associated with mortality after living-donor liver transplantation in the early postoperative period were considered significant (P=.005). MELD scores were also found to be associated with mortality (P=.006). Mortality rates in patients with high MELD scores and a low GBWR were highest among the other combinations. In conclusion, we found that GBWR lower than 1 and MELD score higher than 20 are significant risk factors for mortality after living donor liver transplantation. Patients with low MELD scores can undergo transplantation when their GBWR is lower than 1, but recipients with high MELD scores should receive grafts only when their GBWR is higher than 1.