Liver Transplantation in Recipients With High Model for End-stage Liver Disease Score

Area of Science:

• Hepatology
• Transplant Surgery
• Critical Care Medicine

Background:

• The Model of End-stage Liver Disease (MELD) score is a key predictor of survival for liver transplant candidates.
• Patients with very high MELD scores represent a severe baseline state, potentially impacting transplant outcomes.

Purpose of the Study:

• To evaluate the benefits and outcomes of liver transplantation in patients with very high MELD scores (≥28).
• To compare postoperative complications, intensive care unit (ICU) stay, hospital stay, and survival between patients with MELD scores <28 and ≥28.

Main Methods:

• A prospective study included 331 liver transplant recipients between 2002 and 2014.
• Patients were stratified into two groups based on MELD score: <28 and ≥28.
• Demographic data, postoperative complications, ICU and hospital length of stay, and survival rates were analyzed.

Main Results:

• 21 patients (6.3%) had a MELD score ≥28, with a younger mean age (42.5 vs 53.7 years; P < .0001).
• No significant increase in postoperative complications or difference in survival was observed between groups.
• Patients with MELD ≥28 experienced longer ICU stays (6.7 vs 4.1 days) and hospital admissions (41.5 vs 26.9 days).

Conclusions:

• Very high MELD scores are associated with prolonged ICU and hospital stays post-liver transplant.
• Transplantation in patients with MELD scores ≥28 does not appear to increase postoperative complications or negatively impact survival.
• These findings suggest no contraindication for liver transplantation in patients with very high MELD scores.