Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
The model for end-stage disease (MELD) score is used to stratify candidates for liver transplant (LT) based on objective measures. Since June 2013 with changes in the MELD-based liver allocation (Share 35) there has been a gradual rise in the number of liver transplant recipients with high MELD scores, especially in regions of the U.S with organ shortage.
Aim: To evaluate the results and identify factors that impact outcomes on this patient population.
Methods: Retrospective analysis of adult patients with MELD≥35 who received LT between 6/2006 to 7/2015. Recipient characteristics, simultaneous liver-kidney transplant (SLKT), MELD at listing, MELD at transplant, medical condition at transplant, hemodialysis (HD) before and after transplant, re-operation, and quality of donor graft were analyzed.
Results: 50 patients with MELD≥35 received LT during the study period, 36 were men, mean age was 52 years. 19 (38%) were in ICU at time of transplant. 14 of the 50 (28%) patients received SLKT and two patients had previous LT. Mean calculated MELD at listing was 28 and at transplant was 40 (range 35-53). 38 (76%) patients needed HD pre-transplant and 33 (66%) in the post-transplant period. 19 (38%) underwent re-laparotomy after LT. Mean ICU stay was 12 days. Fifteen (30%) patients were transplanted with suboptimal grafts. Overall patient survival was 89% at 90-days, 83% at 1-year and 61% at 5-years.
5-year survival is higher for not hospitalized patients compared with hospitalized or in ICU at the time of transplant (p=0.49). We found no difference in short and long-term survival between recipients with MELD 35-40 and MELD > 40. The need for HD pre or post-transplant was a predictor of poor outcome.
Conclusion: Expected inferior but acceptable outcomes are achievable after LT in patients with MELD scores of 35 or higher but come at high pre-transplantation and post-transplantation resource utilization. An effort to avoid MELD disparity at transplant among all regions should be a priority to decrease waitlist mortality, improve outcomes and help organ availability.
CITATION INFORMATION: Bertacco A, Rodriguez-Davalos M, Schilsky M, Yoo P, Kulkarni S, Fortune B, Liapakis A, Emre S, Mulligan D. Risk Factors for Short and Long Term Mortality in High MELD Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Bertacco A, Rodriguez-Davalos M, Schilsky M, Yoo P, Kulkarni S, Fortune B, Liapakis A, Emre S, Mulligan D. Risk Factors for Short and Long Term Mortality in High MELD Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-short-and-long-term-mortality-in-high-meld-recipients/. Accessed February 26, 2021.
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