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Prognostic impact of model for end-stage liver disease score in patients undergoing liver transplantation with suboptimal livers.

Abstract：

BACKGROUND/AIMS:The aim of this retrospective study is to analyze the prognostic impact of Model for End-Stage Liver Disease (MELD) score in patients undergoing liver transplantation (OLT) with suboptimal livers. METHODS:Between January 2002 and January 2006, 160 adult patients with liver cirrhosis received a whole liver for primary OLT at our institution including 81 with a suboptimal liver (SOL group) versus 79 with an optimal liver (group OL). The definition of suboptimal liver was: one major criterion (age >60 years, steatosis >20%) or at least two minor criteria: sodium >155 mEq/L, Intensive Care Unit stay >7 days, dopamine >10 microg/kg/min, abnormal liver tests, and relevant hemodynamic instability. RESULTS:Baseline recipients characteristics were comparable in the two study groups. The SOL group had a significantly greater number of early graft deaths (<30 days) than the OL group, while the 3-year Kaplan-Meier patient survivals were similar. Using logistic regression, MELD score was significantly related to patient death only in the SOL group (P = .01), and the receiver operator characteristics curve method identified 17 as the best MELD cutoff with the 3-year survival of 93% versus 85% for MELD < or =7 versus >17, respectively (P > 05). In comparison, it was 94% and 72% in the SOL group (P < .05). Similarly, MELD >17 was significantly associated with early graft death rates only in the SOL group. CONCLUSION:This study advised surgeons to not use suboptimal livers for patients with advanced MELD scores, thus supporting a donor-recipient matching policy.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Vitale A,D'Amico F,Brolese A,Zanus G,Boccagni P,Neri D,Gringeri E,Valmasoni M,Ciarleglio FA,Carraro A,Pauletto A,Bonsignore P,Bassi D,Polacco M,D'Amico DF,Cillo U

doi

10.1016/j.transproceed.2007.05.032

subject

Has Abstract

pub_date

2007-07-01 00:00:00

pages

1907-9

issue

6

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(07)00611-2

journal_volume

39

pub_type

杂志文章

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