OBJECTIVE(S): Liver allocation is prioritized for the sickest patients; however, poorer liver transplant (LTx) outcomes are associated with increasing MELD scores. While MELD is capped at 40, patients can have calculated MELD>40. We sought to determine if outcomes differed for those with calculated scores beyond MELD 40.

METHODS: We performed a single-center study of consecutive adult Ltx between 2012-15. Kaplan-Meier survival and log-rank analyses were used.

RESULTS: 406 LTx were performed with 58 (14.3%) recipients listed at MELD 40. 34 of these had actual MELD scores over 40 (mean 44, range 41-53). Liver disease was from alcohol (38%), HCV (26%), and NASH (12%). MELD 40 and beyond patients were transplanted out of the ICU (69%), with 59% on life-support and 48% mechanically ventilated. Transplants were performed with a short mean CIT of 4 hrs. Ventilator status, ICU status, CIT of 4+ hours, etiology of liver disease, recipient age >50, and need for dialysis were not predictive of graft failure. For those with a MELD 40 or greater, vasopressor requirement at listing was associated with worse graft survival (p=0.04). LTx patient survival 1YR for MELD 40 was 83% compared to 85% for MELD beyond 40 patients (p=0.70). There was no difference in graft survival when those with MELD 40 and greater were compared with MELD <40 (p=0.60).

CONCLUSIONS: LTx for MELD 40 patients and beyond can be performed with better than expected outcomes. Patient selection, operative approaches, and tailored immunosuppression likely contribute to these outcomes.

CITATION INFORMATION: Scalea J, Bruno D, Hanish S, Lamattina J, Alvarez-Casas J, Malik S, Cimeno A, Bartlett S, Barth R. Liver Transplantation Beyond MELD 40. Am J Transplant. 2017;17 (suppl 3).

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