Given current allocation in the United States, patients with low MELD-Na scores (<15) rarely receive livers from deceased donors, yet these patients constitute the majority of new candidates added to the wait list. 3 However, each year, nearly 20% of patients awaiting a liver transplant in the United States die or become too sick for the transplant, 4 demonstrating a severe shortage of donors and the dire necessity to increase the donor pool. 1 The survival benefit has been established for deceased-donor liver transplant for patients with end-stage liver disease at a Model for End-stage Liver Disease incorporating sodium levels (MELD-Na) score 2 of 15 or higher. Liver transplant is a life-saving procedure. This study’s findings challenge current perceptions regarding when LDLT survival benefit occurs. The findings of this study suggest that the life-years gained are comparable to or greater than those conferred by any other lifesaving procedure or by a deceased-donor liver transplant. Living-donor liver transplant recipients gained an additional 13 to 17 life-years compared with patients who never received an LDLT.Ĭonclusions and Relevance An LDLT is associated with a substantial survival benefit to patients with end-stage liver disease even at MELD-Na scores as low as 11. Mortality risk and survival models confirmed a significant survival benefit for patients receiving an LDLT who had a MELD-Na score of 11 or higher (adjusted hazard ratio, 0.64 P = .006). Results The mean (SD) age of the 119 275 study participants was 55.1 (11.2) years, 63% were male, 0.9% were American Indian or Alaska Native, 4.3% were Asian, 8.2% were Black or African American, 15.8% were Hispanic or Latino, 0.2% were Native Hawaiian or Other Pacific Islander, and 70.2% were White. Higher MELD-Na scores (>20) are associated with an increased risk of death. MELD-Na score ranges from 6 to 40 and is well correlated with short-term survival. Secondary outcomes included 1-year relative mortality and risk, time to equal risk, time to equal survival, and the MELD-Na score at which that survival benefit was obtained for individuals who received an LDLT compared with that for individuals who remained on the wait list. Main Outcomes and Measures The primary outcome of this study was life-years saved from receiving an LDLT. Patients listed for retransplant or multiorgan transplant and those with prior kidney or liver transplants were excluded.Įxposures Living-donor liver transplant vs remaining on the wait list. Liver transplant candidates aged 18 years or older who were assigned to the wait list (N = 116 455) or received LDLT (N = 2820) were included. Objective To assess the survival benefit, life-years saved, and the MELD-Na score at which that survival benefit was obtained for individuals who received an LDLT compared with that for individuals who remained on the wait list.ĭesign, Setting, and Participants This case-control study was a retrospective, secondary analysis of the Scientific Registry of Transplant Recipients database of 119 275 US liver transplant candidates and recipients from January 1, 2012, to September 2, 2021. Quantification of lifetime survival benefit and the Model for End-stage Liver Disease incorporating sodium levels (MELD-Na) score range at which benefit outweighs risk in LDLT is necessary to demonstrate its safety and effectiveness. Importance Despite the acceptance of living-donor liver transplant (LDLT) as a lifesaving procedure for end-stage liver disease, it remains underused in the United States. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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