Meld calculator6/7/2023 According to the response to the therapy, the time for the surgery is scheduled. Since 2010, our group has developed a pre-transplant management policy that patients with a planned LDLT surgery are hospitalized before the transplantation for a treatment algorithm applied in an effort to decrease the MELD score. This provides a unique opportunity to manage the patients pre-operatively for optimal clinical conditions and reduce the MELD score. In LDLT, patients are often admitted to the hospital before the anticipated surgery to be able to maximize the management of their liver disease. In a single-center, retrospective analysis of 1,125 patients listed for DDLT, delta MELD as a continuous variable was found to be the only significant risk factor for overall survival after LT ( 8). Multiple studies have accepted the description of “delta MELD” as the maximum change in MELD score calculated at 2 time points between listing and transplantation ( 7– 11). In DDLT, post-LT survival of the patients maintained on the waiting list has a relationship with MELD changes, which has led to some further investigation related to MELD score changes. Therefore, despite the suggestion that the sickest patients are those who derive the highest benefit from LT, the use of LDLT in patients with a high MELD score has been controversial ( 6). It was reported that a MELD score >20 was independently associated with reduced graft survival ( 4), and a MELD score of 25 or higher was evaluated as an independent adverse prognostic factor for in-hospital mortality after LDLT ( 5). An increased post-operative mortality risk has been reported among patients who undergo LDLT with higher MELD scores ( 3). Although the MELD score does not play a role in organ allocation in living donor LT (LDLT), pre-LT disease severity has also been shown as one of the predictive factors for post-transplant patient survival. In deceased donor LT (DDLT), the allocation of organs is based on the model for end-stage liver disease (MELD) scoring system since 2002, which is established as an important predictor of waiting list mortality as well as post-LT mortality risk ( 2). Liver transplantation (LT) is an effective treatment for a wide spectrum of liver diseases, where similar outcomes have been reported either with deceased donor or living donor grafts ( 1).
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