However, 17-AAG supplier the survival benefit of liver transplant has been questioned for candidates
with Model for Endstage Liver Disease (MELD) scores <15, and the survival advantage of LDLT has not been demonstrated during the MELD allocation era, especially for low MELD patients. Transplant candidates enrolled in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study after February 28, 2002 were followed for a median of 4.6 years. Starting at the time of presentation of the first potential living donor, mortality for LDLT recipients was compared to mortality for patients who remained on the waiting list or received DDLT (no LDLT group) according to categories of MELD score (<15 or ≥15) and diagnosis of hepatocellular carcinoma (HCC). Of 868 potential LDLT recipients (453 with MELD <15; 415 with MELD ≥15 at entry), 712 underwent transplantation (406 LDLT; 306 DDLT), 83 died without transplant, and 73 were alive without transplant at last follow-up. Overall, LDLT recipients had 56% lower mortality (hazard ratio [HR] = 0.44, 95% confidence interval [CI] 0.32-0.60; P < 0.0001). Among candidates without HCC, mortality benefit was seen both with MELD <15 (HR = 0.39; P = 0.0003) and MELD
≥15 (HR = 0.42; P = 0.0006). Among candidates with HCC, a benefit of LDLT was not seen for MELD <15 (HR = 0.82, P = 0.65) but was seen for MELD ≥15 (HR = 0.29, P = 0.043). Conclusion: Across the range of MELD scores, patients without HCC derived a significant survival benefit when undergoing LDLT rather than waiting for DDLT in the MELD
liver allocation era. Low MELD candidates SCH 900776 mouse with HCC may not benefit from LDLT. (HEPATOLOGY 2011;54:1313–1321) Following the introduction of adult-to-adult living donor liver transplantation (LDLT) in the U.S. in the late 1990s, the procedure gained in popularity and in 2001 represented approximately 8% of all adult liver transplants performed in the U.S. Subsequently, use of the procedure declined from 412 cases in Thymidylate synthase 2001 to 168 LDLT in the U.S in 2009 (www.optn.transplant.hrsa.gov accessed 08/13/10). Previous retrospective reports by the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) identified a survival benefit for patients who received LDLT as compared to waiting for, or receiving, a deceased donor liver transplant (DDLT).1 That report employed data accrued over the early years of LDLT in nine active liver transplant centers in the U.S. More than 70% of the potential liver transplant recipients enrolled in that retrospective cohort study were evaluated in the era before the Model for Endstage Liver Disease (MELD) score was employed for deceased donor liver allocation in the U.S. (February 28, 2002), and thus the benefits of pursuing LDLT as compared to waiting for deceased donor liver transplant (DDLT) in the MELD allocation era are not well understood.