Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

Abstract

IntroductionThe impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival.MethodsWe retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters.ResultsThis study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio [OR] 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2).ConclusionsThis study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity.

Model for End-stage Liver Disease

“…In one study, MELD score of more than 23 predicted a higher morbidity and prolonged ICU stay. 29 In another study, there was about 55% increased cost of transplanting a patient as compared to pre-MELD era. 30 However, data on increased resource utilization since the implementation of MELD score are controversial with no such change reported in a large database retrospective study.…”

Erişkin Ortotopik Karaciğer Transplantasyonu Sonrası Uzamış Yoğun Bakım Gereksiniminin Ön Belirleyicileri

“…Literatürde bildirilen uzam›fl yo¤un bak›m gereksinimi s›kl›¤› kullan›lan farkl› tan›mlara göre de¤iflkenlik göstermektedir. Ancak retrospektif bir analizde karaci¤er transplantasyonundan sonra yo¤un bak›mda yat›fl süresinin ortalama 9 gün olarak bildirilmesi bu hastalarda uzam›fl yo¤un bak›m gereksiniminin s›k oldu¤unu göstermektedir (9). Sumberaz ve ark.…”

“…MELD skorunun karaci¤er transplant al›c›lar›n›n sa¤-kal›m› üzerindeki etkisi konusunda çeliflkili çal›flmalar mevcuttur (9,(12)(13)(14)(15). Tsui TY ve ark.…”

“…(9) çal›flmalar›nda intraoperatif 10 ünite üzerindeki taze donmufl plazma ve 7 ünite üzerindeki eritrosit süspansiyonu transfüzyonlar›n›n uzam›fl yo¤un bak›m süresi için ba¤›ms›z risk faktörleri olduklar›n› göster-mifllerdir (9). Allojenik taze donmufl plazma transfüzyonu ile inflamasyon, koagülasyon yollar›n›n ve immünolojik reaksiyonlar›n aktivasyonu ile beraber viral ve bakteriyel enfeksiyon insidans›n›n artmas› ile bu iliflki aç›klanabilir (16)(17)(18).…”

“…Karaci¤er transplantasyonundan sonra akut böbrek hasar›n›n s›k ortaya ç›kt›¤› ve bu durumun yüksek MELD skoru ile iliflkili oldu¤u bildirilmifltir (9). Ayn› çal›flmada akut böbrek hasar› gelifliminin mortalite ile iliflkili olabilece¤i de vurgulanm›flt›r.…”