Prognostic Impact of Model for End-Stage Liver Disease Score in Patients Undergoing Liver Transplantation With Suboptimal Livers

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doi:10.1016/j.transproceed.2007.05.032 Copyright © 2007 Elsevier Inc. All rights reserved.

Prognostic Impact of Model for End-Stage Liver Disease Score in Patients Undergoing Liver Transplantation With Suboptimal Livers

A. Vitalea,, F. D’Amicob, A. Broleseb, G. Zanusb, P. Boccagnib, D. Nerib, E. Gringerib, M. Valmasonib, F.A. Ciarlegliob, A. Carrarob, A. ettob, P. Bonsignoreb, D. Bassib, M. Polaccob, D.F. D’Amicob and U. Cillob aUnità di Chirurgia Oncologica, Istituto Oncologico Veneto, IOV-IRCCS, Padova, ItalybUnità di Chirurgia Epatobiliare e Trapianto Epatico, Università—Dipartimento assistenziale di Chirurgia Generale e Trapianti d’Organo–Università, Azienda Ospedaliera di Padova, Padova, Italy. Available online 8 August 2007. Abstract

Background/aims The aim of this retrospective study is to analyze the prognostic impact of Model for End-Stage Liver Disease (MELD) score in patients undergoing liver transplantation (OLT) with suboptimal livers. Methods Between January 2002 and January 2006, 160 adult patients with liver cirrhosis received a whole liver for primary OLT at our institution including 81 with a suboptimal liver (SOL group) versus 79 with an optimal liver (group OL). The definition of suboptimal liver was: one major criterion (age >60 years, steatosis >20%) or at least two minor criteria: sodium >155 mEq/L, Intensive Care Unit stay >7 days, dopamine >10 μg/kg/min, abnormal liver tests, and relevant hemodynamic instability. Results Baseline recipients characteristics were comparable in the two study groups. The SOL group had a significantly greater number of early graft deaths (<30 days) than the OL group, while the 3-year Kaplan-Meier patient survivals were similar. Using logistic regression, MELD score was significantly related to patient death only in the SOL group (P = .01), and the receiver operator characteristics curve method identified 17 as the best MELD cutoff with the 3-year survival of 93% versus 85% for MELD ≤7 versus >17, respectively (P > 05). In comparison, it was 94% and 72% in the SOL group (P < .05). Similarly, MELD >17 was significantly associated with early graft death rates only in the SOL group. Conclusion This study advised surgeons to not use suboptimal livers for patients with advanced MELD scores, thus supporting a donor-recipient matching policy.

Address reprint requests to Alessandro Vitale, MD, Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IOV-IRCCS, Padova—Via Giustiniani 2, 35128 Padova, Italy.

Transplantation Proceedings Volume 39, Issue 6, July-August 2007, Pages 1907-1909