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Published on: August 17, 2022
Analysis of liver transplantation outcome in patients with MELD Score > or = 30
B H Ferraz-Neto1, M P V C Zurstrassen, R Hidalgo
1Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. ben-hur@einstein.br
Abstract:
Since July 2006, the liver graft allocation has been changed from the waiting time to the Model for End-stage Liver Disease (MELD), prioritizing the sickest patients, who have a higher risk of dying on the waiting list, and sometimes in such poor clinical condition that it compromises transplantation outcomes. The aim of this study was to analyze the impact of a MELD score > or = 30 on 30-day survival after liver transplantation (OLT). We prospectively collected the data on 178 liver transplants on 163 patients performed from March 2003 to August 2007. The subjects were divided in two groups according to their MELD scores: group 1, MELD > or = 30 (n = 15) and group 2, MELD < 30 (n = 96). The groups were compared with regard to hospital and intensive care unit (ICU) length of stay, intraoperative blood products transfusion, early survival (30 days), and need for retransplantation. We excluded, patients with prioritization criteria, those receiving extra points for any special situation, and six other patients without significant data for MELD calculation (of whom only one has died after transplantation). Patients under a "special situation" were those with hepatocelular carcinoma, hepatopulmonary syndrome, and metabolic diseases, who initially received a MELD/PELD score 20, and 24, and 29. The mean MELD score at group I was 34 (range, 30 to 42), and for group II it was 16 (range, 6 to 29). Group I displayed a mean hospital length of stay of 24 days (4 to 155), with 12.60 days (ranges, 1 to 103) in the ICU versus 15.55 (range, 1 to 48) and 5.13 (range, 1 to 45) days, respectively, for group II. The need for blood component transfusions were greater in group I; 25.28% of patients in group II did not receive any transfusion during the entire inpatient period. There were nine retransplants in group II, and none in group I. The 30-day survivals were 93.3% for group I and 84.37% for group II. Besides the increased complexity of these sickest patients, there was no negative impact on early survival rates.
Insights
Liver transplant recipients with a high Model for End-stage Liver Disease (MELD) score (≥30) showed improved 30-day survival rates. This study indicates that prioritizing sicker patients does not negatively impact early outcomes after liver transplantation.
Area of Science:
- Hepatology
- Transplantation Surgery
- Medical Informatics
Background:
- Liver graft allocation shifted from waiting time to the Model for End-stage Liver Disease (MELD) score in July 2006.
- This change prioritizes critically ill patients, who are at higher risk of mortality on the waiting list.
- The clinical condition of severely ill patients can sometimes compromise transplantation outcomes.
Purpose of the Study:
- To analyze the impact of a MELD score of 30 or higher on 30-day survival after orthotopic liver transplantation (OLT).
- To compare outcomes between patients with high MELD scores and those with lower scores.
Main Methods:
- Prospective data collection on 163 patients undergoing 178 liver transplants between March 2003 and August 2007.
- Patients divided into two groups: MELD ≥30 (n=15) and MELD <30 (n=96).
- Exclusion of patients with prioritization criteria or special situation points; comparison of hospital/ICU length of stay, blood product transfusion, 30-day survival, and retransplantation rates.
Main Results:
- The high MELD group (≥30) had a mean MELD of 34, compared to 16 in the lower MELD group (<30).
- Higher rates of blood product transfusion were observed in the high MELD group.
- Despite increased complexity, the 30-day survival rate was 93.3% for the high MELD group versus 84.37% for the lower MELD group; no retransplants occurred in the high MELD group.
Conclusions:
- A MELD score of 30 or higher did not negatively impact 30-day survival rates after liver transplantation.
- Prioritizing the sickest patients based on MELD score appears safe and effective for early post-transplant outcomes.
- The MELD system effectively identifies patients who benefit most from timely liver transplantation without compromising early survival.