Ann Liver Transplant.  2021 May;1(1):2-9. 10.52604/alt.21.0002.

Prognostic impact of MELD scores greater than 40 in deceased donor liver transplant recipients

• Na BG
• Hwang S
• Park GC
• Song GW
• Jung DH
• Ha TY
• Ahn CS
• Moon DB
• Kim KH
• Yoon YI
• Kang WH
• Cho HD
• Kim M
• Kim SH
• Lee SG

• KMID: 2560847
• DOI: http://doi.org/10.52604/alt.21.0002

Abstract

Background
Since 2016, Korean liver organ allocation system has been based on model for end-stage liver disease (MELD). Some patients on waiting list progressed to MELDs >40 due to serious shortage of donor organs. This study investigated prognosis of deceased donor liver transplantation (DDLT) recipients with MELD scores >40.
Methods
Data from adult patients with MELD scores ≥31 who underwent DDLT between June 2016 and November 2019 were retrospectively evaluated. Patients were categorized according to Korean Network for Organ Sharing (KONOS) status 3, 2, or MELD-over-40.
Results
During the study period, 168 DDLT operations were performed in 160 patients with KONOS status 3 in 77 (48.1%), status 2 in 65 (40.6%) and MELD-over-40 in 18 (11.3%). Graft survival rates of primary DDLT were 84.0% at 1 year and 70.7% at 3 years. Overall patient survival was 85.2% at 1 year and 70.7% at 3 years. The 3-year patient survival was 74.4%, 75.7%, and 52.7% in KONOS status 3, status 2, and MELD-over-40 groups (p=0.19). Pretransplant ventilator support was associated with inferior patient survival outcomes (p=0.043), but pretransplant renal replacement therapy showed no prognostic significance. Retransplantation showed a significant prognostic difference (p<0.001). Multivariate analysis for overall patient survival showed that pretransplant ventilator support and retransplantation were significant prognostic factors, but MELD score >40 was not seen to be an independent risk factor.
Conclusion
This analysis revealed that very high MELD scores >40 appear to confer additional risk in patients with KONOS status 2 although it was not an independent prognostic factor.

Keyword

Deceased donor; Mortality; Waiting list; Ventilator; Marginal graft

Figure

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  Figure 1 Patient survival (A) and graft survival (B) curves after liver transplantation.

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  Figure 2 Comparison of the patient survival (A) and graft survival (B) curves according to the model for end-stage liver disease (MELD) scores.

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  Figure 3 Comparison of the patient survival curves according to the primary liver diseases (A), pretransplant ventilator support (B), pretransplant renal replacement therapy (C), and retransplantation (D). ALD, alcoholic liver disease; SALF, subacute liver failure; HBV-LC, hepatitis B virus-associated liver cirrhosis; HCV-LC, hepatitis C virus-associated liver disease.

Reference

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