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The large volume of adult living donor liver transplantations ( ALDLT s) at our center affords a unique opportunity to examine the impact of acute‐on‐chronic liver failure ( ACLF ) among high–Model for End‐Stage Liver Disease  MELD  score patients. From February 1998 to March 2010, 1958 cirrhotic recipients were analyzed to study the relationship between  MELD  scores and  ALDLT  outcomes. A total of 327 high‐ MELD  score recipients were categorized into  ACLF  and non‐ ACLF  groups, and their outcomes were compared. The 5‐year graft and patient survival in the high‐ MELD  group were 75.2% and 76.4%, respectively, which were significantly worse than the low and intermediate  MELD  groups. The presence of  ACLF  associated with higher  MELD  scores appeared to be the dominant factor responsible for the inferior results of patients with  MELD  score of 30–34 points. The 5‐year graft survivals in the  ACLF  group was 70.5% and in the non‐ ACLF  group it was 81.0% (p = 0.035). Therefore,  ALDLT  should be performed as soon as possible in high‐ MELD  score patients prior to  ACLF  development. Moreover,  ACLF  patients should be separately categorized when analyzing the outcomes of  ALDLT .  ALDLT  for  ACLF  patients should not be discouraged because favorable outcomes can be expected through timely  ALDLT  and comprehensive management.

Adult Living Donor Liver Transplantation for Acute‐on‐Chronic Liver Failure in High–Model for End‐Stage Liver Disease Score Patients