MELD Score Before and After Plasmapheresis in Recipients of ABO-Incompatible Living Donor Liver Transplantation

Background: In ABO-incompatible living donor liver transplantation (LDLT), many strategies including plasmapheresis have been introduced to overcome the ABO blood group barrier. After plasmapheresis, the MELD score can change because the levels of its three components [international normalized ratio (INR), total bilirubin (Tb), and creatinine (Cr)] may be affected. Method: Present study included 142 recipients of ABO-incompatible LDLT. MELD score was calculated according to the original formula [11.2 ln (INR) + 3.78 ln (Tb) + 9.56 ln (Cr) + 6.43]. We compared the MELD score and the three components of the MELD score before and after plasmapheresis. Results: In the entire cohort, MELD score decreased from 13 to 11 after plasmapheresis. MELD score increased in 41 (28.9%), maintained in 25 (17.6%), and decreased in 76 (53.5%) recipients. The change of INR, Tb, and Cr was mostly in the same direction as the change of MELD score. Conclusion: MELD scores of ABO-incompatible LDLT recipients mostly change after plasmapheresis. Decline in MELD score was most common, followed by rise and maintenance.