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Войти в исследования Journal of clinical and experimental hepatology · 2026
Outcome-Gap Analysis of High-MELD Deceased-donor Liver Transplantation Using Institutional Reference Values from Living-donor Liver Transplantation.
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Park Hyojun, Gil Eunmi, Oh Namkee, Rhu Jinsoo, Kim Jongman, Park Chi-Min, Choi Gyu-Seong
Аннотация
BACKGROUND/OBJECTIVES: Benchmarking in liver transplantation has largely relied on low-risk deceased-donor or multicenter cohorts. We derived living-donor liver transplantation (LDLT)-based institutional reference values and evaluated domain-specific outcome gaps in high-Model for End-Stage Liver Disease (MELD) deceased-donor liver transplantation (DDLT) in an LDLT-dominant setting.
METHODS: Adult liver-transplant recipients treated at a high-volume tertiary center between June 2016 and December 2024 were analyzed. A predefined low-risk LDLT cohort was used to derive institutional reference values. Continuous cutoffs were defined as the 75th percentile of the LDLT distribution, and binary endpoints as observed LDLT event rates. High-MELD DDLT outcomes were assessed across clinical resource use, global morbidity, organ/graft dysfunction, survival/graft outcomes, and biliary-vascular complications.
RESULTS: The cohort included 423 LDLT reference recipients and 203 high-MELD DDLT recipients. LDLT-derived cutoffs were 7.39 h for operation duration, 2 red blood cell (RBC) units, 4 intensive care unit (ICU) days, and 24 hospital days. High-MELD DDLT exceeded reference values for transfusion, ICU stay, 30-day Clavien-Dindo (C-D) grade ≥ III morbidity (49.8% vs 29.3%; gap +20.4 percentage points [pp]), acute kidney injury (AKI) stage ≥3 (6.9% vs 1.7%; gap +5.2), and early allograft dysfunction (EAD) (40.4% vs 8.7%; gap +31.6). One-year graft and patient survival were lower in high-MELD DDLT (73.6% vs 92.1% and 76.9% vs 94.5%). Biliary complications showed negative gaps, indicating graft-type-dependent morbidity that required separate interpretation.
CONCLUSIONS: LDLT-derived institutional reference values identified high-MELD DDLT outcome gaps, mainly in clinical resource use, major morbidity, organ/graft dysfunction, graft loss, and mortality. These values may help describe excess burden without serving as exclusion thresholds.
METHODS: Adult liver-transplant recipients treated at a high-volume tertiary center between June 2016 and December 2024 were analyzed. A predefined low-risk LDLT cohort was used to derive institutional reference values. Continuous cutoffs were defined as the 75th percentile of the LDLT distribution, and binary endpoints as observed LDLT event rates. High-MELD DDLT outcomes were assessed across clinical resource use, global morbidity, organ/graft dysfunction, survival/graft outcomes, and biliary-vascular complications.
RESULTS: The cohort included 423 LDLT reference recipients and 203 high-MELD DDLT recipients. LDLT-derived cutoffs were 7.39 h for operation duration, 2 red blood cell (RBC) units, 4 intensive care unit (ICU) days, and 24 hospital days. High-MELD DDLT exceeded reference values for transfusion, ICU stay, 30-day Clavien-Dindo (C-D) grade ≥ III morbidity (49.8% vs 29.3%; gap +20.4 percentage points [pp]), acute kidney injury (AKI) stage ≥3 (6.9% vs 1.7%; gap +5.2), and early allograft dysfunction (EAD) (40.4% vs 8.7%; gap +31.6). One-year graft and patient survival were lower in high-MELD DDLT (73.6% vs 92.1% and 76.9% vs 94.5%). Biliary complications showed negative gaps, indicating graft-type-dependent morbidity that required separate interpretation.
CONCLUSIONS: LDLT-derived institutional reference values identified high-MELD DDLT outcome gaps, mainly in clinical resource use, major morbidity, organ/graft dysfunction, graft loss, and mortality. These values may help describe excess burden without serving as exclusion thresholds.