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. 2010;14(3):R117.
doi: 10.1186/cc9068. Epub 2010 Jun 15.

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

Christian E Oberkofler  1 , Philipp Dutkowski, Reto Stocker, Reto A Schuepbach, John F Stover, Pierre-Alain Clavien, Markus Béchir
Affiliations

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

Christian E Oberkofler et al. Crit Care. 2010.

Abstract

Introduction: The impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival.

Methods: We retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters.

Results: This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio [OR] 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2).

Conclusions: This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity.

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Figures

Figure 1
Figure 1
ICU complications of the 147 ICU cases. ACS, acute coronary syndrome; PGN, primary graft nonfunction; RF, respiratory failure; RRT, renal replacement therapy.
Figure 2
Figure 2
Kaplan Meier analysis of cumulative graft survival (dashed line) and cumulative patient's survival (full line). Graph shows results for 144 patients and 151 grafts.
Figure 3
Figure 3
Influence of MELD score on (a) mortality and (b) length of stay in the ICU of more than 10 days. There was a significant higher model of end-stage liver disease (MELD) in the group, which stayed longer in the ICU (grey box). In contrast there was no difference in MELD in respect to mortality. (a) 24 no survivors vs. 104 survivors. (b) 35 with a long ICU stay versus 93 short time ICU patients. ns, not significant.
See this image and copyright information in PMC

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