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29 January 2015 : Original article  

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

Alexander KaltenbornABCDEFG, Catharina HartmannBCDEF, Ricardo SalinasBDE, Wolf RamackersBDE, Moritz KleineBDE, Florian W.R. VondranBDE, Marc BartholdCDEG, Frank LehnerBDE, Jürgen KlempnauerBDEG, Harald SchremABCDEFG

DOI: 10.12659/AOT.892322

Ann Transplant 2015; 20:59-69

Abstract

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.

Keywords: Aftercare, Follow-Up Studies, Liver Transplantation, Multivariate Analysis, Postoperative Complications

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358