Somewhat unexpectedly, there was no significant difference in the frequency of these complications in those candidates for whom LDLT was seriously contemplated

(i.e., for whom a donor was evaluated at their transplant center) and in those who did not have such a donor. Despite this objective finding, there remains the possibility that experienced transplant teams still may have applied some selection bias in the recommendation of pursuit of LDLT in their centers such that the reported survival benefit may not be universally obtained by all candidates. Given this possibility, one should Proteasome assay remain cautious about the generalized pursuit of LDLT in all candidates with low MELD scores presenting to transplant centers. Future analyses of very large cohorts of LDLT recipients may permit the further identification of subsets of candidates who receive maximal benefit from this procedure. The majority

of transplant candidates in the A2ALL retrospective study1 underwent both listing and transplant prior to the initiation of the MELD-based liver allocation system. In the current MELD era analysis, candidates who enrolled in A2ALL with MELD ≥15, who did not have HCC, and who received LDLT, had markedly lower mortality compared to those waiting for or receiving DDLT (HR 0.42, 95% CI 0.26-0.69; P = 0.0006). This NVP-AUY922 solubility dmso survival benefit was similar to that previously reported by our group1 and strongly supports the continued application of LDLT in this group of patients with higher MELD scores. As there were only 27 patients enrolled in A2ALL in the post-MELD era with MELD scores at enrollment of greater than 30, and only eight of these patients received LDLT, we were unable to perform an analysis restricted to transplant candidates with very high MELD scores and cannot comment on the presence or absence of possible futility associated

with LDLT in these high MELD candidates. Fifteen percent of the patients in the current analysis carried a diagnosis of HCC. As detailed in Table 1, patients who ultimately went on to receive LDLT were more likely to have stage T3 or higher tumors than those who received DDLT, most likely as a consequence of standardized (higher) exception Interleukin-2 receptor MELD scores for those with stage T2 HCC, which permitted relatively expeditious DDLT. It is of note that despite the relatively large percentage of patients with T3 tumors, fairly quick access to DDLT was noted for the HCC patients with lower laboratory MELD scores, such that wait times for DDLT for these patients was far less than that for non-HCC candidates (7.9 months median wait for DDLT for MELD <15 candidates without HCC who received DDLT versus 2.2 months median wait for MELD <15 candidates with HCC). This wait time for DDLT for low MELD HCC patients was similar to the wait time for LDLT in this group (median 1.6 months). In this setting, the lack of a survival advantage associated with receipt of LDLT for low MELD HCC transplant candidates was not surprising.