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. 2017 Mar 20;12(3):e0174173.
doi: 10.1371/journal.pone.0174173. eCollection 2017.

High MELD score and extended operating time predict prolonged initial ICU stay after liver transplantation and influence the outcome

Panagiota Stratigopoulou  1 , Andreas Paul  1 , Dieter P Hoyer  1 , Stylianos Kykalos  1 , Fuat H Saner  1 , Georgios C Sotiropoulos  1
Affiliations

High MELD score and extended operating time predict prolonged initial ICU stay after liver transplantation and influence the outcome

Panagiota Stratigopoulou et al. PLoS One. .

Abstract

Background: The aim of the present study is to determine the incidence of a prolonged (>3 days) initial ICU-stay after liver transplantation (LT) and to identify risk factors for it.

Patients and methods: We retrospectively analyzed data of adult recipients who underwent deceased donor first-LT at the University Hospital Essen between 11/2003 and 07/2012 and showed a primary graft function.

Results: Of the 374 recipients, 225 (60.16%) had prolonged ICU-stay. On univariate analysis, donor INR, high doses of vasopressors, "rescue-offer" grafts, being hospitalized at transplant, high urgency cases, labMELD, alcoholic cirrhosis, being on renal dialysis and length of surgery were associated with prolonged ICU-stay. After multivariate analysis, only the labMELD and the operation's length were independently correlated with prolonged ICU-stay. Cut-off values for these variables were 19 and 293.5 min, respectively. Hospital stay was longer for patients with a prolonged initial ICU-stay (p<0.001). Survival rates differed significantly between the two groups at 3 months, 1-year and 5-years after LT (p<0.001).

Conclusions: LabMELD and duration of LT were identified as independent predictors for prolonged ICU-stay after LT. Identification of recipients in need of longer ICU-stay could contribute to a more evidenced-based and cost-effective use of ICU facilities in transplant centers.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of patients included in the study.
Fig 2
Fig 2. Receiver Operating Characteristic curve (ROC) curve associated with the logistic regression model.
Fig 3
Fig 3. Receiver Operating Characteristic (ROC) curve for LabMELD.
Fig 4
Fig 4. Box-Whisker-Plot depicting the influence of labMELD score on the length of ICU stay.
Fig 5
Fig 5. Box-Whisker-Plot depicting the influence of the duration of operation on the length of ICU stay.
Fig 6
Fig 6. Kaplan-Meier survival analysis in LT recipients with and without a prolonged ICU stay after LT.
A) 3 months, 12-months and 60-months patient-survival rates are shown. B) 3-month, 12- month and 60- month graft-survival rates are shown.
See this image and copyright information in PMC

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