Survival outcomes in liver transplant recipients with Model for End-stage Liver Disease scores of 40 or higher: a decade-long experience

BACKGROUND: The Model for End-stage Liver Disease (MELD) has been used as a prognostic tool since 2002 to predict pre-transplant mortality. Increasing proportions of transplant candidates with higher MELD scores, combined with improvements in transplant outcomes, mandate the need to study surgical outcomes in patients with MELD scores of \u3e/=40. METHODS: A retrospective longitudinal analysis of United Network for Organ Sharing (UNOS) data on all liver transplantations performed between February 2002 and June 2011 (n = 33 398) stratified by MELD score (/=40) was conducted. The primary outcomes of interest were short- and longterm graft and patient survival. A Kaplan-Meier product limit method and Cox regression were used. A subanalysis using a futile population was performed to determine futility predictors. RESULTS: Of the 33 398 transplant recipients analysed, 74% scored/=40 at transplantation. Recipients with MELD scores of \u3e/=40 were more likely to be younger (P \u3c 0.001), non-White and to have shorter waitlist times (P \u3c 0.001). Overall patient survival correlated inversely with increasing MELD score; this trend was consistent for both short-term (30 days and 90 days) and longterm (1, 3 and 5 years) graft and patient survival. In multivariate analysis, increasing age, African-American ethnicity, donor obesity and diabetes were negative predictors of survival. Futility predictors included patient age of \u3e60 years, obesity, peri-transplantation intensive care unit hospitalization with ventilation, and multiple comorbidities. CONCLUSIONS: Liver transplantation in recipients with MELD scores of \u3e/=40 offers acceptable longterm survival outcomes. Futility predictors indicate the need for prospective follow-up studies to define the population to gain the highest benefit from this precious resource

Plexus 2009

Sponsors: School of Medicine Dean’s Office, Office of Educational Affairs, Office of AdmissionsThe PLEXUS staff wishes to recognize the hard work and support of the following: Ellena Peterson, PhD; Johanna Shapiro, PhD; Dale Fakuda from Printing Division Inc.Last Year’s Editors: Rod Mortazavi, Neera SodhiCo-editors in Chief: Charitha Reddy, Maheen HassanManaging Editor: Mohammad ShaikhSenior EditorsAudio: Joe TreisterHospital Beautification: Christina UmberCreative Writing: Jennifer Aloo, Mohammad ShaikhLayout & Design: Maheen HassanMarketing & Outreach: Madhukar PatelVisual Arts: Charitha ReddyAssociate EditorsAudio: Matthew FradkinCreative Writing: Nupoor NarulaLayout & Design: Chase WarrenMarketing & Outreach: Phillip NgaiVisual Arts: Phillip NgaiSelection Editor: Justin TilanStaff: Clifford Lau, Alexander Lin, Kirellos Zamary, Virginia LiuFaculty Advisor: Johanna Shapiro, PhDUCI School of Medicine (c) 2009 PLEXUSPublished works were contributed by UCI School of Medicine students, physicians, faculty, alumni, and patients