TPW 8.01 High MELD Scores Are Not a Contraindication to Living Donor Liver Transplantation (LDLT): Acceptable Survival Outcomes in MELD >40 versus ≤40 LDLT Recipients

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ID: 323917
2026
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Abstract
Abstract Background Patients with Model for End-Stage Liver Disease (MELD) scores >40 face exceptionally high waitlist mortality. Living-donor-liver-transplantation (LDLT) for this critically ill cohort remains contentious due to concerns regarding perioperative-risk and suboptimal outcomes. Objectives To determine whether LDLT achieves equivalent survival in MELD >40 patients compared to lower-severity recipients and to characterize the clinical risk-benefit profile. Methods Retrospective analysis of prospectively maintained data from a high-volume center encompassed 2,600 adult LDLT procedures (2010-2021). 74 MELD >40 recipients were compared against 2,015 MELD ≤40 recipients. Propensity score matching (1:3 ratio, 0.2 SD caliper) balanced 16 baseline covariates including demographics, disease severity, comorbidities, and transplant factors, achieving standardized mean differences <0.1. Primary outcomes were patient and allograft survival, analyzed via Kaplan-Meier estimation and stratified Cox regression. Secondary outcomes assessed perioperative complications, rejection episodes, and biochemical recovery through postoperative day 10. Results MELD >40 recipients demonstrated excellent outcomes. One-year survival reached 85.4% versus 87.5% for MELD ≤40 (HR 0.94, 95% CI 0.45-1.95, P=0.87), with five-year survival of 70.8% versus 68.2% (HR 0.98, P=0.95). Propensity-matched analysis revealed no significant differences: one-year survival 91.7% versus 88.9% (P=0.74), five-year graft survival 66.7% versus 64.8% (P=0.88). High-MELD recipients achieved 91% median bilirubin reduction (24.3 to 2.1 mg/dL) by day 10. Although requiring more perioperative dialysis (25.0% versus 10.8%, P=0.04), rejection rates (12.5% versus 14.5%, P=0.80) remained comparable. Conclusions LDLT delivers exceptional long-term survival for MELD >40 patients, with outcomes equivalent to lower-risk recipients, challenging existing paradigms and supporting LDLT as safe, effective intervention at experienced centers.
Reference Key
openalex_W7172489228 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Selvakumar Naganathan, Hemant Sharma, Subash Gupta
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.390
URL
https://doi.org/10.1093/bjs/znag087.390
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