{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:28:40Z","timestamp":1771979320090,"version":"3.50.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Previous recommendations suggested living donor liver transplantation (LDLT) should not be considered for patients with Model for End\u2010Stage Liver Disease (MELD) &gt; 25 and hepatorenal syndrome (HRS).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>Patients who were listed with MELD &gt; 25 from 2008 to 2017 were analyzed with intention\u2010to\u2010treat (ITT) basis retrospectively. Patients who had a potential live donor were analyzed as ITT\u2010LDLT, whereas those who had none belonged to ITT\u2010deceased donor liver transplantation (DDLT) group. ITT\u2010overall survival (OS) was analyzed from the time of listing. Three hundred twenty\u2010five patients were listed (ITT\u2010LDLT n\u00a0=\u00a0212, ITT\u2010DDLT n\u00a0=\u00a0113). The risk of delist\/death was lower in the ITT\u2010LDLT group (43.4% vs. 19.8%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001), whereas the transplant rate was higher in the ITT\u2010LDLT group (78.3% vs. 52.2%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). The 5\u2010year ITT\u2010OS was superior in the ITT\u2010LDLT group (72.6% vs. 49.5%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) for patients with MELD &gt; 25 and patients with both MELD &gt; 25 and HRS (56% vs. 33.8%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). Waitlist mortality was the highest early after listing, and the distinct alteration of slope at survival curve showed that the benefits of ITT\u2010LDLT occurred within the first month after listing. Perioperative outcomes and 5\u2010year patient survival were comparable for patients with MELD &gt; 25 (88% vs. 85.4%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.279) and patients with both MELD &gt; 25 and HRS (77% vs. 76.4%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.701) after LDLT and DDLT, respectively. The LDLT group has a higher rate of renal recovery by 1 month (77.4% vs. 59.1%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.003) and 3 months (86.1% vs, 74.5%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.029), whereas the long\u2010term estimated glomerular filtration rate (eGFR) was similar between the 2 groups. ITT\u2010LDLT reduced the hazard of mortality (hazard ratio\u00a0=\u00a00.387\u20100.552) across all MELD strata.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The ITT\u2010LDLT reduced waitlist mortality and allowed an earlier access to transplant. LDLT in patients with high MELD\/HRS was feasible, and they had similar perioperative outcomes and better renal recovery, whereas the long\u2010term survival and eGFR were comparable with DDLT. LDLT should be considered for patients with high MELD\/HRS, and the application of LDLT should not be restricted with a MELD cutoff.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31584","type":"journal-article","created":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T09:11:48Z","timestamp":1601629908000},"page":"2441-2454","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":33,"title":["Analysis of Survival Benefits of Living Versus Deceased Donor Liver Transplant in High Model for End\u2010Stage Liver Disease and Hepatorenal Syndrome"],"prefix":"10.1097","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3142-7678","authenticated-orcid":false,"given":"Tiffany Cho\u2010Lam","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1286-8902","authenticated-orcid":false,"given":"James Yan\u2010Yue","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Medicine,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Medicine,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herbert H.","family":"Pang","sequence":"additional","affiliation":[{"name":"School of Public Health,The University of Hong Kong,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calvin Ka\u2010Lam","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoi\u2010Fan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sui\u2010Ling","family":"Sin","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ka\u2010Wing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian Wong\u2010Hoi","family":"She","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff Wing\u2010Chiu","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert Chi\u2010Yan","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tan\u2010To","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong Kong,China"},{"name":"Department of Surgery,Queen Mary Hospital,Hong Kong,China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung\u2010Mau","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Surgery,The University of Hong Kong,Hong 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