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Outcomes of liver transplant recipients with high MELD scores: an experience from a Canadian centre
Michael S Bleszynski1, Subin Punnen1, Sameer Desai1
1From the Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, B.C. (Bleszynski, Punnen, Desai Chartier-Plante, Segedi, Scudamore, Chung, Buczkowski, Kim); the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, B.C. (Hussaini); and the Department of Medicine, Division of Gastroenterology, University of British Columbia Vancouver, B.C. (Marquez, Yoshida, Jayakumar).
Background:
The frequency with which patients with high Model for End-Stage Liver Disease (MELD) scores undergo liver transplantation has been increasing. Canadian literature regarding the outcomes of liver transplantation in recipients with high MELD scores is limited. The primary objective of this study was to assess patient and graft survival among recipients with high (> 35) and low (≤ 35) MELD scores. Secondary objectives were to potentially identify independent predictors of graft failure and patient mortality.
Methods:
We conducted a retrospective chart review of patients undergoing liver transplantation at a single Canadian centre from 2012 to 2017.
Results:
A total of 332 patients were included in the study: 280 patients had a MELD score of 35 or lower, and 52 had a MELD score above 35. Patients with high MELD scores had higher rates of pretransplant acute kidney injury and dialysis (p < 0.001), admission to the intensive care unit (ICU) or intubation (p < 0.001), intraoperative blood product transfusions (p < 0.001) and post-transplantation acute kidney injury and dialysis (p < 0.001), as well as longer ICU (p < 0.001) and hospital stays (p = 0.002). One- and 3-year patient survival in recipients with MELD scores of 35 or lower was 93.1% and 84.9% versus 85.0% and 80.0% in recipients with MELD scores above 35 (p = 0.37). One- and 3-year graft survival in recipients with MELD scores of 35 or lower was 91.7% and 90.9% versus 77.2% and 72.8% in recipients with MELD scores above 35 (p < 0.001). Prior liver transplant was an independent predictor of patient mortality, and no independent predictors of graft failure were identified. When MELD was replaced with D-MELD (donor age × recipient MELD), it predicted graft failure but not patient survival.
Conclusion:
No difference in patient mortality was found between MELD groups. Graft survival was significantly lower in recipients with MELD scores above 35. D-MELD may potentially be used as an adjunct in determining risk of graft failure in recipients with high MELD scores.
Insights
Liver transplant outcomes show no difference in patient survival but significantly lower graft survival for high Model for End-Stage Liver Disease (MELD) scores. Donor-MELD may predict graft failure in these patients.
Area of Science:
- Hepatology
- Transplant Surgery
- Nephrology
Background:
- Increasing trend of liver transplantation for high Model for End-Stage Liver Disease (MELD) scores.
- Limited Canadian literature on outcomes for high MELD score liver transplant recipients.
- High MELD scores are associated with increased pre-transplant complications.
Purpose of the Study:
- Assess patient and graft survival in high (>35) versus low (≤35) MELD score liver transplant recipients.
- Identify independent predictors of graft failure and patient mortality.
- Evaluate the utility of Donor-MELD (D-MELD) in predicting outcomes.
Main Methods:
- Retrospective chart review of liver transplantations at a single Canadian center (2012-2017).
- Inclusion of 332 patients, categorized by MELD score (≤35 vs. >35).
- Comparison of pre-transplant and post-transplant complications, survival rates, and predictor variables.
Main Results:
- Patients with high MELD scores experienced higher rates of acute kidney injury, ICU admission, and longer hospital stays.
- One- and 3-year patient survival rates were similar between high and low MELD groups (85.0%/80.0% vs. 93.1%/84.9%).
- One- and 3-year graft survival was significantly lower in the high MELD group (77.2%/72.8% vs. 91.7%/90.9%).
- Prior liver transplant was an independent predictor of patient mortality.
- Donor-MELD predicted graft failure but not patient survival.
Conclusions:
- No significant difference in patient mortality between high and low MELD score groups.
- Graft survival is significantly compromised in liver transplant recipients with MELD scores above 35.
- Donor-MELD shows potential as an adjunct tool for assessing graft failure risk in high MELD recipients.
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