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Impact of the Model for End-stage Liver Disease (MELD) score on liver transplantation in Greece
A Karapanagiotou1, C Kydona1, C Dimitriadis2
1Intensive Care Unit "Hippokratio" Hospital, Thessaloniki, Greece.
Introduction:
The impact of preoperative Model for End-stage Liver Disease (MELD) score in postoperative mortality remains unclear. The assumption that patients with a higher MELD score will have a higher mortality rate is not confirmed and studies are contradictory.
Aim:
The study of the clinical course of patients with a higher MELD score and its impact in immediate and later mortality in comparison with patients with a lower MELD score in the only liver transplantation center in Greece.
Method:
We retrospectively studied 71 patients who underwent orthotopic liver transplantation (OLT) in the time period between 1-1-2011 and 31-12-2013. The patients were divided into 2 groups: Group A with a MELD score ≥23 and Group B with a MELD score <23.
Results:
In the patients with a MELD score ≥23 the duration of mechanical ventilation and length of stay in the ICU were prolonged (P = .013 and .009, respectively), the transfusions were more (P = .005), and the rates of ICU readmissions (22.5% vs 7.31%, P = .001) and infections (42.5% vs 17.5%, P = .011) were higher. Thirty-day mortality did not differ between the 2 groups (P = .420), but there was a statistically significant difference in morbidity and in 180-day mortality.
Conclusion:
The patients with a higher MELD score have more complex pathophysiology. This score seems to affect morbidity and late, but not early, mortality.
Insights
Higher Model for End-stage Liver Disease (MELD) scores in liver transplant patients are linked to increased complications and later mortality, but not immediate death. This finding impacts how we assess transplant outcomes.
Area of Science:
- Hepatology
- Transplantation Surgery
- Critical Care Medicine
Background:
- The predictive value of the preoperative Model for End-stage Liver Disease (MELD) score on postoperative mortality after liver transplantation is debated.
- Existing studies present contradictory findings regarding the correlation between higher MELD scores and increased mortality rates.
Purpose of the Study:
- To investigate the clinical course and mortality impact of higher MELD scores versus lower MELD scores in liver transplant recipients.
- To compare immediate and late mortality rates between these patient groups at Greece's sole liver transplantation center.
Main Methods:
- A retrospective analysis of 71 patients undergoing orthotopic liver transplantation (OLT) between January 1, 2011, and December 31, 2013.
- Patients were stratified into two groups: Group A (MELD score ≥23) and Group B (MELD score <23).
Main Results:
- Patients with MELD scores ≥23 experienced prolonged mechanical ventilation and ICU stays (P = .013, P = .009).
- Higher MELD scores correlated with increased transfusion needs (P = .005), ICU readmissions (22.5% vs 7.31%, P = .001), and infection rates (42.5% vs 17.5%, P = .011).
- No significant difference in 30-day mortality was observed (P = .420), but morbidity and 180-day mortality were significantly higher in the elevated MELD group.
Conclusions:
- Elevated preoperative MELD scores indicate a more complex patient pathophysiology.
- The MELD score appears to influence postoperative morbidity and late mortality, but not early (30-day) mortality following liver transplantation.
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