Survival after living donor liver transplantation versus best supportive care in patients with end-stage liver disease with various MELD-Na scores: Retrospective cohort study

Liver transplantation is an effective treatment for end-stage liver disease1 3, but the shortage of available organs means that not all patients can undergo the procedure4. This is especially true for patients with low Model for End-Stage Liver Disease (MELD) or MELD incorporating sodium level (MELD-Na) scores, as the organ allocation policy is based on these scores5 7. As a result, patients with low MELD or MELD-Na scores face a limited chance of receiving a deceased donor liver transplant, leading to high mortality rates. In the USA, the 5-year cumulative incidence of mortality rates for low MELD-Na patients (scores ≤15) can be as high as 18.6 per cent8. To address the organ shortage, living donor liver transplantation (LDLT) has emerged particularly in East Asian countries9, and more than half of the LDLT recipients in Korea over the past 5 years had MELD scores ≤1510. A recent study using the Scientific Registry of Transplant Recipients (SRTR) database from the USA found that LDLT was associated with a survival benefit in patients with MELD-Na scores as low as 1111. Given the extensive experience of Eastern expert centres in performing LDLT over the past three decades, this study was designed to determine the survival benefit of LDLT in patients with end-stage liver disease compared with best supportive care (BSC).