Department of Gastroenterology and Hepatology, Section of Transplant Hepatology, Johns Hopkins University School of Medicine Baltimore, MD, USA;Department of Gastroenterology and Organ Transplantation Center, Sakarya University School of Medicine, Sakarya, Turkey.
Department of Gastroenterology and Organ Transplantation Center, Koc University School of Medicine, İstanbul, Turkey.
Turk J Gastroenterol. 2020 Nov;31(11):782-789. doi: 10.5152/tjg.2020.18761.
BACKGROUND/AIMS: An increased post-operative mortality risk has been reported among patients who undergo living donor liver transplantation (LDLT) with higher model for end-stage liver disease (MELD) scores. In this study, we investigated the effect of MELD score reduction on post-operative outcomes in patients with a high MELD (≥20) score by pre-transplant management.
We retrospectively analyzed 386 LDLT cases, and patients were divided into low-MELD (<20, n=293) vs. high-MELD (≥20, n=93) groups according to their MELD score at the time of index hospitalization. Patients in the high-MELD group were managed specifically according to a treatment algorithm in an effort to decrease the MELD score. Patients in the high-MELD group were further divided into 2 subgroups: (1) responders (n=34) to pre-transplant treatment with subsequent reduction of the MELD score by a minimum of 1 point vs. (2) non-responders (n=59), whose MELD score remained unchanged or further increased on the day of LDLT. Responders vs. non-responders were compared according to etiology, demographics, and survival.
背景/目的：据报道，在接受活体供肝移植（LDLT）的患者中，MELD 评分较高的患者术后死亡风险增加。本研究通过移植前管理，调查了 MELD 评分较高（≥20）患者中 MELD 评分降低对术后结局的影响。
我们回顾性分析了 386 例 LDLT 病例，根据指数住院时的 MELD 评分，患者分为低 MELD（<20，n=293）与高 MELD（≥20，n=93）组。高 MELD 组的患者根据治疗算法进行专门管理，以降低 MELD 评分。高 MELD 组的患者进一步分为 2 个亚组：（1）对移植前治疗有反应（n=34），随后 MELD 评分至少降低 1 分，与（2）无反应（n=59）患者，即 LDLT 当天 MELD 评分保持不变或进一步增加。根据病因、人口统计学和生存情况对有反应者与无反应者进行比较。
