*Purpose: The Model for End-Stage Liver Disease (MELD) score has been used for predicting waitlist outcomes in patients with cirrhosis. However, the post-transplant prognostic value of MELD scores considered limited. We hypothesized that there would be populations which might not be suitable for LDLT and comparing risk factors in living and deceased donor LT (LDLT and DDLT) would provide useful selection criteria to avoid futile LDLT. In this study, we aimed to identify unique risk factors for poor post-transplant outcome in LDLT and DDLT and assess post-transplant prognostic value of the MELD score in LDLT.

*Methods: This study used data from United Network for Organ Sharing (UNOS) STAR file and includedalladult (≥ 18 years old) recipients who received LT from 2011 to 2018 (LDLT, n =1515; DDLT, n =39802). We stratified recipients by MELD score at LT into the following groups: 6-11, 12-14, 15-19, 20-24, 25-29, 30-34, 35-39, ≥ 40. Risk factors for one year-graft survival were analyzed based on the LT donor types by using a multivariate Cox’s regression model.

*Results: In DDLT, one year-graft survival in patients with MELD scores ≥30 was significantly worse than that of patients in any other group with MELD scores ≤29. In LDLT, because there were only 24 patients with MELD ≥30, we could not analyze its prognostic effect There was no significant difference between 5 score groups with MELD scores ≤ 29 both in DDLT and LDLT. Multivariate analysis revealed that recipient BMI <18.5, black race, moderate/severe encephalopathy, donor age >50 years were associated with poor graft survival both in DDLT and LDLT. Moderate/severe ascites was an independent risk factor in LDLT; whereas recipient age ≥50, recipient BMI >40, poor functional status, recipient diabetes, dialysis requirement, cold ischemia time, and donation after cardiac death donor were independent risk factors in DDLT.

*Conclusions: While increasing the number of living donors may allow expansion of the donor pool,careful consideration should be given to the indication for LDLT in patients with high MELD score, given poor post-transplant outcomes in DDLT patients with MELD score ≥30. Negative impact of moderate/severe ascites was significant in LDLT, but not in DDLT, this can potentially be attributed to smaller graft size in the presence of severe portal hypertension.

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