Postoperative Resource Utilization and Survival Among Liver Transplant Recipients with Model for End-stage Liver Disease Score ≥ 40: A Retrospective Cohort Study

Overview

Journal Can J Gastroenterol Hepatol

Specialty Gastroenterology

Date 2015 May 13

PMID 25965438

Citations 6

Authors

Filipe S Cardoso

Constantine J Karvellas

Norman M Kneteman

Glenda Meeberg

Pedro Fidalgo

Sean M Bagshaw

Affiliations

Soon will be listed here.

Abstract

Background: Cirrhotic patients with Model for End-stage Liver Disease (MELD) score ≥ 40 have high risk for death without liver transplant (LT).

Objective: To evaluate these patients' outcomes after LT.

Methods: The present study analyzed a retrospective cohort of 519 cirrhotic adult patients who underwent LT at a single Canadian centre between 2002 and 2012. Primary exposure was severity of liver disease measured by MELD score at LT (≥ 40 versus < 40). Primary outcome was duration of first intensive care unit (ICU) stay after LT. Secondary outcomes were duration of first hospital stay after LT, rate of ICU readmission, re-LT and survival rates.

Results: On the day of LT, 5% (28 of 519) of patients had a MELD score ≥ 40. These patients had longer first ICU stays after LT (14 versus two days; P < 0.001). MELD score ≥ 40 at LT was independently associated with first ICU stay after LT ≥ 10 days (OR 3.21). These patients had longer first hospital stays after LT (45 versus 18 days; P < 0.001); however, there was no significant difference in the rate of ICU readmission (18% versus 22%; P = 0.58) or re-LT rate (4% versus 4%; P = 1.00). Cumulative survival at one month, three months, one year, three years and five years was 98%, 96%, 90%, 79% and 72%, respectively. There was no significant difference in cumulative survival stratified according to MELD score ≥ 40 versus < 40 at LT (P = 0.59).

Conclusions: Cirrhotic patients with MELD score ≥ 40 at LT utilize greater postoperative health resources; however, they derive similar long-term survival benefit from LT.

Citing Articles

The effects of prognostic factors on transplant and mortality of patients with end-stage liver disease using Markov multistate model.

Madreseh E, Mahmoudi M, Toosi M, Abolghasemi J, Zeraati H J Res Med Sci. 2023; 28:28.

PMID: 37213466 PMC: 10199371. DOI: 10.4103/jrms.jrms_1091_21.

Approaches for patients with very high MELD scores.

Artru F, Samuel D JHEP Rep. 2020; 1(1):53-65.

PMID: 32039352 PMC: 7001538. DOI: 10.1016/j.jhepr.2019.02.008.

The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation.

Pereira C, Carvalho A, Bosco A, Forgiarini Junior L Rev Bras Ter Intensiva. 2019; 31(1):57-62.

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[Frontiers in liver transplantation in indication and techniques].

Schoning W, Ollinger R, Schmelzle M, Pratschke J Chirurg. 2018; 90(2):102-109.

PMID: 30413847 DOI: 10.1007/s00104-018-0761-8.

Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population.

Pedersen M, Choi M, Brink J, Seetharam A J Transplant. 2016; 2016:6787854.

PMID: 27980860 PMC: 5131244. DOI: 10.1155/2016/6787854.

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