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Risk Factors for Short- and Long-Term Mortality in Liver Transplant Recipients with MELD Score ≥30

Alexander Kaltenborn, Catharina Hartmann, Ricardo Salinas, Wolf Ramackers, Moritz Kleine, Florian W.R. Vondran, Marc Barthold, Frank Lehner, Jürgen Klempnauer, Harald Schrem

(Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany)

Ann Transplant 2015; 20:59-69

DOI: 10.12659/AOT.892322

Background: After introduction of MELD-based allocation in Germany, decreased waiting list mortality and increased mortality after transplantation have been reported.
Material and Methods: This study compares relevant outcome parameters in patients with high MELD ≥30 versus lower MELD scores in a retrospective analysis including 454 consecutively performed liver transplantations in adults (age >16 years) at Hannover Medical School between 01/01/2007 and 31/12/2012 and a follow-up until 31/12/2013. Multivariable risk-adjusted models were applied to identify independent risk factors for 90-day and long-term mortality.
Results: MELD score ≥30 (n=117; 26.1%) was an independent risk factor for 90-day mortality (p=0.004, odds ratio: 3.045, 95% CI 1.439–6.498) and long-term mortality (p=0.016, hazard ratio: 1.620, 95% CI 1.095–2.396) and was associated with significantly longer hospital and intensive care unit stays (p<0.001), and death occurred in more cases earlier after transplantation (90-day mortality 21.6% vs. 13.0%; p=0.029). Portal vein thrombosis at transplantation was significantly associated with 90-day mortality after transplantation in patients with MELD scores ≥30 (p=0.041), but this was not the case for patients with MELD scores <30, although portal vein thrombosis was equally frequent in individuals of both groups (3.0% vs. 3.4%, p=0.824).
Conclusions: Results of this study suggest that liver transplant recipients with portal vein thrombosis at transplantation should be transplanted before reaching a MELD score ≥30.

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