Clinical outcomes of adult living donor liver transplantation (LDLT) in high MELD recipients: A systematic review and meta-analysis

Introduction: LDLT may provide equivalent outcomes in high-MELD as in low-MELD patients. The aim was to compare LDLT in high-MELD against low-MELD recipients to determine patient survival and graft survival, perioperative and postoperative complication
Methods: 10 studies with 490 HM-LDLT recipients and 1,693 LM-LDLT recipients.
Results: Both groups had comparable mortality at 1,3 and 5 years posttransplant(5-year HR 1.19; 95%CI 0.79-1.79;P-value 0.40) and graft survival HR 1.08; 95%CI 0.72, 1.63;P-value 0.71). No differences were observed in rates of major morbidity, hepatic artery thrombosis, biliary complications, intraabdominal bleeding, wound infection and rejection; however, HM-LDLT group had higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay.
Conclusions: In conclusion, high-MELD LDLT group had similar patient & graft survival and morbidities to low-MELD LDLT group despite higher risk for pulmonary infection, abdominal fluid collection and ICU stay.