12 for all except TIPSS; for MELD ≥15, P > 0.13 for all except ascites). The donor risk index (DRI) provides a quantitative assessment of the risk of donor liver graft failure. Calculation of the DRI provides an objective measure of the quality of organs accepted by transplant centers for deceased donor liver transplantation. We compared donor risk index (DRI)9 for DDLT recipients enrolled in A2ALL and DDLT recipients from the same centers but not enrolled in A2ALL. Median DRI for non-HCC DDLT recipients with MELD <15 at listing enrolled in A2ALL was 1.35

and was 1.40 for 1458 DDLT recipients not enrolled in A2ALL with MELD <15 at listing who were transplanted at the nine participating centers (P = 0.94). For non-HCC DDLT

recipients with MELD ≥15 at listing, the median DRI was 1.33 for A2ALL patients and 1.34 for 2999 non-A2ALL-enrolled DDLT recipients (P = 0.45). Finally, we compared post-DDLT CYC202 manufacturer mortality for non-HCC DDLT recipients. For non-HCC patients with MELD <15 at listing, post-DDLT mortality HR was 0.79 (P = 0.23) for A2ALL patients compared with non-A2ALL-enrolled patients. For non-HCC patients with MELD ≥15 at listing, post-DDLT mortality HR was 1.00 (P = 0.98) for A2ALL patients compared to non-A2ALL-enrolled patients. These analyses were adjusted for recipient age, MELD at transplant, and DRI. One hundred thirty of 868 (15.0%) of the A2ALL transplant candidates carried a diagnosis of HCC at the time of enrollment. Of these, 93 had a laboratory (nonexception) MELD <15 at almost study entry and 37 had MELD ≥15 at study entry. Tumor stages at the time check details of study entry are presented in Table 1 for these two groups of transplant

candidates. Among the 93 transplant candidates in the MELD <15 group, 32 HCC patients received LDLT at a median of 1.6 months after initial living liver donor evaluation, 49 received DDLT at a median of 2.2 months after study entry, and 12 had not undergone any transplant by last follow-up, including seven who died on the waitlist. Among the 37 transplant candidates in the MELD ≥15 group, 17 HCC patients went on to receive LDLT at a median of 1.8 months after initial living donor evaluation, 16 received DDLT at a median of 3.1 months after first living donor evaluation, and four had not undergone any transplant at last follow-up, three of whom died on the waitlist. In an adjusted sequential stratification analysis of time from initial donor evaluation to death for transplant candidates with MELD <15 and HCC at study entry, we were unable to detect a significant survival benefit for LDLT recipients compared to patients who did not receive LDLT (HR = 0.82, 95% CI 0.36-1.89; P = 0.65). In a similar analysis for patients with MELD ≥15 at study entry and HCC, patients who underwent LDLT had significantly lower mortality risk than those who did not receive LDLT (HR = 0.29, 95% CI 0.09-0.96; P = 0.043).