Markov modeling suggested a benefit associated with receipt of LDLT VX-809 cost in patients with hepatocellular carcinoma (HCC)2, 3 compared with waiting for DDLT. Experience from A2ALL, however, demonstrated higher rates of posttransplant recurrence in liver transplant

candidates with HCC who underwent LDLT.4 Similarly, there is uncertainty regarding whether there is a survival benefit associated with receipt of LDLT among transplant candidates with MELD <15. Two recent large database analyses of the U.S. liver transplant population have suggested that a survival benefit is obtained by transplant candidates undergoing transplantation with MELD scores in excess of 155 or 126 in comparison to remaining on the waiting list. Analyses

from the retrospective cohort study reported by A2ALL suggested a survival benefit for transplant candidates enrolled in A2ALL with laboratory (nonexception) MELD scores less than 15, although the majority of those patients were actually transplanted Tyrosine Kinase Inhibitor Library chemical structure in the pre-MELD allocation era.1 To resolve some of the uncertainties delineated above, and better inform liver transplant candidates regarding transplant outcomes in the current allocation paradigm, we examined data from A2ALL for liver transplant candidates who entered into the study following the introduction of the MELD-based liver allocation system on February 28, 2002 through August 31, 2009. Outcomes for these patients who presented to A2ALL transplant centers with their first potential living donor during this period were analyzed in order to assess the potential benefit of receipt of LDLT based on transplant candidate MELD score and presence or absence of HCC. The study design, which examined patient outcomes from the time of first living donor evaluation, was created to allow clinicians to counsel transplant candidates and their donors when the opportunity for LDLT presented itself check details in the transplant clinic setting. A2ALL, adult to adult living donor

liver transplant study; DDLT, deceased donor liver transplant; DRI, donor risk index; HCC, hepatocellular carcinoma; LDLT, living donor liver transplant; MELD, model for endstage liver disease; SRTR, Scientific Registry for Transplant Recipients; TIPSS, transjugular intrahepatic portosystemic shunt. A primary objective of the A2ALL study has been to identify transplant candidates who accrue a survival benefit from adult LDLT. In order to encompass both pretransplant events and posttransplant survival, patient entry into the study occurred on the date that each potential LDLT candidate’s first potential living donor presented for initial donor history and physical examination at one of the nine A2ALL transplant centers as previously described.