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Critical Care
Published in: Critical Care 3/2010

Open Access 01-06-2010 | Research

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

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

Published in: Critical Care | Issue 3/2010

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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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Literature
1.
Sagmeister M, Mullhaupt B: Is living donor liver transplantation cost-effective? J Hepatol 2005, 43: 27-32. 10.1016/j.jhep.2005.05.005CrossRefPubMed
2.
Sachdev M, Hernandez JL, Sharma P, Douglas DD, Byrne T, Harrison ME, Mulligan D, Moss A, Reddy K, Vargas HE, Rakela J, Balan V: Liver transplantation in the MELD era: a single-center experience. Dig Dis Sci 2006, 51: 1070-1078. 10.1007/s10620-006-8011-1CrossRefPubMed
3.
Martin AP, Bartels M, Hauss J, Fangmann J: Overview of the MELD score and the UNOS adult liver allocation system. Transplant Proc 2007, 39: 3169-3174. 10.1016/j.transproceed.2007.04.025CrossRefPubMed
4.
Ravaioli M, Grazi GL, Ballardini G, Cavrini G, Ercolani G, Cescon M, Zanello M, Cucchetti A, Tuci F, Del Gaudio M, Varotti G, Vetrone G, Trevisani F, Bolondi L, Pinna AD: Liver transplantation with the Meld system: a prospective study from a single European center. Am J Transplant 2006, 6: 1572-1577. 10.1111/j.1600-6143.2006.01354.xCrossRefPubMed
5.
Tsui TY, Scherer MN, Schnitzbauer AA, Schlitt HJ, Obed A: Adult living donor liver transplantation: body mass index and MELD score of recipients are independent risk factors for hospital mortality. Langenbecks Arch Surg 2009, 394: 235-241. 10.1007/s00423-008-0348-9CrossRefPubMed
6.
7.
Ferraz-Neto BH, Zurstrassen MP, Hidalgo R, Meira-Filho SP, Rezende MB, Paes AT, Afonso RC: Analysis of liver transplantation outcome in patients with MELD Score > or = 30. Transplant Proc 2008, 40: 797-799. 10.1016/j.transproceed.2008.03.016CrossRefPubMed
8.
Santoyo J, Suarez M, Fernandez-Aguilar J, Perez Daga J, Sanchez-Perez B, Ramirez C, Aranda J, Rodriguez-Canete A, Gonzalez-Sanchez A: True impact of the indication of cirrhosis and the MELD on the results of liver transplantation. Transplant Proc 2006, 38: 2462-2464. 10.1016/j.transproceed.2006.08.015CrossRefPubMed
9.
Saner FH, Sotiropoulos GC, Radtke A, Fouzas I, Molmenti EP, Nadalin S, Paul A: Intensive care unit management of liver transplant patients: a formidable challenge for the intensivist. Transplant Proc 2008, 40: 3206-3208. 10.1016/j.transproceed.2008.08.069CrossRefPubMed
10.
McGilvray ID, Greig PD: Critical care of the liver transplant patient: an update. Curr Opin Crit Care 2002, 8: 178-182. 10.1097/00075198-200204000-00015CrossRefPubMed
11.
Saner F, Kavuk I, Lang H, Fruhauf NR, Paul A, Stavrou G, Malago M, Broelsch CE: Postoperative ICU management in liver transplant patients. Eur J Med Res 2003, 8: 511-516.PubMed
12.
Cholongitas E, Marelli L, Shusang V, Senzolo M, Rolles K, Patch D, Burroughs AK: A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transpl 2006, 12: 1049-1061. 10.1002/lt.20824CrossRefPubMed
13.
14.
Adam R, Bismuth H, Diamond T, Ducot B, Morino M, Astarcioglu I, Johann M, Azoulay D, Chiche L, Bao YM, et al.: Effect of extended cold ischaemia with UW solution on graft function after liver transplantation. Lancet 1992, 340: 1373-1376. 10.1016/0140-6736(92)92559-XCrossRefPubMed
15.
Merion RM, Goodrich NP, Feng S: How can we define expanded criteria for liver donors? J Hepatol 2006, 45: 484-488. 10.1016/j.jhep.2006.07.016CrossRefPubMed
16.
Arroyo V, Gines P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, Reynolds TB, Ring-Larsen H, Scholmerich J: Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996, 23: 164-176. 10.1002/hep.510230122CrossRefPubMed
17.
Salerno F, Gerbes A, Gines P, Wong F, Arroyo V: Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007, 56: 1310-1318.PubMedCentralPubMed
18.
McCormack L, Selzner M, Clavien P-A: The transplant operation. In Medical Care of Liver Transplantation. Edited by: Killenberg P, Clavien P-A. Oxford, England: Blackwell Publishing; 2006:229-241.
19.
Yantorno SE, Kremers WK, Ruf AE, Trentadue JJ, Podesta LG, Villamil FG: MELD is superior to King's college and Clichy's criteria to assess prognosis in fulminant hepatic failure. Liver Transpl 2007, 13: 822-828. 10.1002/lt.21104CrossRefPubMed
20.
Siniscalchi A, Cucchetti A, Toccaceli L, Spiritoso R, Tommasoni E, Spedicato S, Dante A, Riganello L, Zanoni A, Cimatti M, Pierucci E, Bernardi E, Miklosova Z, Pinna AD, Faenza S: Pretransplant model for end-stage liver disease score as a predictor of postoperative complications after liver transplantation. Transplant Proc 2009, 41: 1240-1242. 10.1016/j.transproceed.2009.02.046CrossRefPubMed
21.
Saab S, Wang V, Ibrahim AB, Durazo F, Han S, Farmer DG, Yersiz H, Morrisey M, Goldstein LI, Ghobrial RM, Busuttil RW: MELD score predicts 1-year patient survival post-orthotopic liver transplantation. Liver Transpl 2003, 9: 473-476. 10.1053/jlts.2003.50090CrossRefPubMed
22.
Bazarah SM, Peltekian KM, McAlister VC, Bitter-Suermann H, MacDonald AS: Utility of MELD and Child-Turcotte-Pugh scores and the Canadian waitlisting algorithm in predicting short-term survival after liver transplant. Clin Invest Med 2004, 27: 162-167.PubMed
23.
Kremers WK, van IM, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH: MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients. Hepatology 2004, 39: 764-769. 10.1002/hep.20083CrossRefPubMed
24.
Narayanan Menon KV, Nyberg SL, Harmsen WS, DeSouza NF, Rosen CB, Krom RA, Wiesner RH: MELD and other factors associated with survival after liver transplantation. Am J Transplant 2004, 4: 819-825. 10.1111/j.1600-6143.2004.00433.xCrossRefPubMed
25.
Kogure T, Ueno Y, Kawagishi N, Kanno N, Yamagiwa Y, Fukushima K, Satomi S, Shimosegawa T: The model for end-stage liver disease score is useful for predicting economic outcomes in adult cases of living donor liver transplantation. J Gastroenterol 2006, 41: 1005-1010. 10.1007/s00535-006-1887-xCrossRefPubMed
26.
Chang T-J: Prognostic factors of postoperative ARF. Dialysis & Transplatation 1999, 29: 114-123.
27.
Faenza S, Santoro A, Mancini E, Pareschi S, Siniscalchi A, Zanzani C, Pinna AD: Acute renal failure requiring renal replacement therapy after orthotopic liver transplantation. Transplant Proc 2006, 38: 1141-1142. 10.1016/j.transproceed.2006.02.151CrossRefPubMed
28.
Fraley DS, Burr R, Bernardini J, Angus D, Kramer DJ, Johnson JP: Impact of acute renal failure on mortality in end-stage liver disease with or without transplantation. Kidney Int 1998, 54: 518-524. 10.1046/j.1523-1755.1998.00004.xCrossRefPubMed
29.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005, 294: 813-818. 10.1001/jama.294.7.813CrossRefPubMed
30.
Cabezuelo JB, Ramirez P, Acosta F, Sanchez Bueno F, Robles R, Pons JA, Miras M, Munitiz V, Fernandez JA, Lujan J, Rodriguez JM, Bru M, Berenguer JJ, Parrilla P: Prognostic factors of early acute renal failure in liver transplantation. Transplant Proc 2002, 34: 254-255. 10.1016/S0041-1345(01)02749-XCrossRefPubMed
31.
de Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F: Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000, 26: 915-921. 10.1007/s001340051281CrossRefPubMed
32.
Faenza S, Bernardi E, Cimatti M, Dante A, Mancini E, Miklosova Z, Piraccini E, Pierucci E, Riganello I, Spedicato S, Zanoni A, Santoro A: Acute renal failure after liver transplantation in MELD era. Transplant Proc 2007, 39: 1945-1946. 10.1016/j.transproceed.2007.05.050CrossRefPubMed
33.
Biancofiore G, Davis CL: Renal dysfunction in the perioperative liver transplant period. Curr Opin Organ Transplant 2008, 13: 291-297. 10.1097/MOT.0b013e328300a058CrossRefPubMed
34.
Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N: Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am J Transplant 2006, 6: 2651-2659. 10.1111/j.1600-6143.2006.01526.xCrossRefPubMed
35.
Planinsic RM, Lebowitz JJ: Renal failure in end-stage liver disease and liver transplantation. Int Anesthesiol Clin 2006, 44: 35-49. 10.1097/01.aia.0000210807.24298.f7CrossRefPubMed
36.
Cabezuelo JB, Ramirez P, Rios A, Acosta F, Torres D, Sansano T, Pons JA, Bru M, Montoya M, Bueno FS, Robles R, Parrilla P: Risk factors of acute renal failure after liver transplantation. Kidney Int 2006, 69: 1073-1080. 10.1038/sj.ki.5000216CrossRefPubMed
37.
Shaw BW Jr, Martin DJ, Marquez JM, Kang YG, Bugbee AC Jr, Iwatsuki S, Griffith BP, Hardesty RL, Bahnson HT, Starzl TE: Venous bypass in clinical liver transplantation. Ann Surg 1984, 200: 524-534. 10.1097/00000658-198410000-00013PubMedCentralCrossRefPubMed
38.
Shaw BW Jr, Martin DJ, Marquez JM, Kang YG, Bugbee AC Jr, Iwatsuki S, Griffith BP, Hardesty RL, Bahnson HT, Starzl TE: Advantages of venous bypass during orthotopic transplantation of the liver. Semin Liver Dis 1985, 5: 344-348. 10.1055/s-2008-1040631PubMedCentralCrossRefPubMed
39.
Gallardo M, Gutierrez M, Pérez G, Balsera E, Ortega J, Garcia G: Risk factors for renal dysfunction in the postoperative course of liver transplant. Liver Transpl 2004, 10: 1379-1385. 10.1002/lt.20215CrossRef
40.
Ruiz R, Barri YM, Jennings LW, Chinnakotla S, Goldstein RM, Levy MF, McKenna GJ, Randall HB, Sanchez EQ, Klintmalm GB: Hepatorenal syndrome: a proposal for kidney after liver transplantation (KALT). Liver Transpl 2007, 13: 838-843. 10.1002/lt.21149CrossRefPubMed
41.
Weismuller TJ, Prokein J, Becker T, Barg-Hock H, Klempnauer J, Manns MP, Strassburg CP: Prediction of survival after liver transplantation by pre-transplant parameters. Scand J Gastroenterol 2008, 43: 736-746. 10.1080/00365520801932944CrossRefPubMed
42.
Ruiz R, Kunitake H, Wilkinson AH, Danovitch GM, Farmer DG, Ghobrial RM, Yersiz H, Hiatt JR, Busuttil RW: Long-term analysis of combined liver and kidney transplantation at a single center. Arch Surg 2006, 141: 735-741. discussion 741-732 10.1001/archsurg.141.8.735CrossRefPubMed
43.
Lo CM, Fan ST, Liu CL, Yong BH, Wong Y, Lau GK, Lai CL, Ng IO, Wong J: Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg 2004, 240: 151-158. 10.1097/01.sla.0000129340.05238.a0PubMedCentralCrossRefPubMed
44.
Marik PE, Wood K, Starzl TE: The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transplant 2006, 21: 478-482. 10.1093/ndt/gfi212PubMedCentralCrossRefPubMed
45.
Cherry T, Steciuk M, Reddy VV, Marques MB: Transfusion-related acute lung injury: past, present, and future. Am J Clin Pathol 2008, 129: 287-297. 10.1309/D3F7BXH466AE3G0PCrossRefPubMed
46.
Klein HG, Spahn DR, Carson JL: Red blood cell transfusion in clinical practice. Lancet 2007, 370: 415-426. 10.1016/S0140-6736(07)61197-0CrossRefPubMed
47.
Tinmouth A, Fergusson D, Yee IC, Hebert PC: Clinical consequences of red cell storage in the critically ill. Transfusion 2006, 46: 2014-2027. 10.1111/j.1537-2995.2006.01026.xCrossRefPubMed
48.
de Rougemont O, Dutkowski P, Weber M, Clavien P-A: Abdominal drains in liver transplantation: useful tool or useless dogma? A match case-control study. Liver Transpl 2009, 15: 96-101. 10.1002/lt.21676CrossRefPubMed
49.
Massicotte L, Lenis S, Thibeault L, Sassine MP, Seal RF, Roy A: Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations. Liver Transpl 2006, 12: 117-123. 10.1002/lt.20559CrossRefPubMed
50.
Nardo B, Bertelli R, Montalti R, Beltempo P, Puviani L, Pacile V, Cavallari A: Red blood cell transfusion in liver transplantation: a case-control study. Transplant Proc 2005, 37: 4389-4392. 10.1016/j.transproceed.2005.11.030CrossRefPubMed
51.
Rueggeberg A, Boehm S, Napieralski F, Mueller AR, Neuhaus P, Falke KJ, Gerlach H: Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients. Anaesthesia 2008, 63: 1174-1180. 10.1111/j.1365-2044.2008.05604.xCrossRefPubMed
52.
Smith JO, Shiffman ML, Behnke M, Stravitz RT, Luketic VA, Sanyal AJ, Heuman DM, Fisher RA, Cotterell AH, Maluf DG, Posner MP, Sterling RK: Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes. Liver Transpl 2009, 15: 273-279. 10.1002/lt.21731CrossRefPubMed
53.
McCormack L, Petrowsky H, Jochum W, Mullhaupt B, Weber M, Clavien PA: Use of severely steatotic grafts in liver transplantation: a matched case-control study. Ann Surg 2007, 246: 940-946. discussion 946-948 10.1097/SLA.0b013e31815c2a3fCrossRefPubMed
54.
Tector AJ, Mangus RS, Chestovich P, Vianna R, Fridell JA, Milgrom ML, Sanders C, Kwo PY: Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. Ann Surg 2006, 244: 439-450.PubMedCentralPubMed
55.
Candel FJ, Grima E, Matesanz M, Cervera C, Soto G, Almela M, Martinez JA, Navasa M, Cofan F, Ricart MJ, Perez-Villa F, Moreno A: Bacteremia and septic shock after solid-organ transplantation. Transplant Proc 2005, 37: 4097-4099. 10.1016/j.transproceed.2005.09.181CrossRefPubMed
56.
Singh N, Paterson DL, Gayowski T, Wagener MM, Marino IR: Predicting bacteremia and bacteremic mortality in liver transplant recipients. Liver Transpl 2000, 6: 54-61.PubMed
57.
Angus DC, Wax RS: Epidemiology of sepsis: an update. Crit Care Med 2001, 29: S109-116. 10.1097/00003246-200107001-00035CrossRefPubMed
58.
Gurusamy KS, Kumar Y, Davidson BR: Systematic review on preventing bacterial sepsis and wound complications in liver transplant patients methods of preventing bacterial sepsis and wound complications for liver transplantation. Cochrane Database Syst Rev 2008, CD006660.
59.
Dellinger RP, Carlet JM, Gerlach H, Ramsey G, Levy M: The surviving sepsis guidelines: not another "groundhog day". Crit Care Med 2004, 32: 1601-1602. 10.1097/01.CCM.0000130996.14896.F6CrossRefPubMed
60.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008, 34: 17-60. 10.1007/s00134-007-0934-2PubMedCentralCrossRefPubMed
Metadata
Title
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
Authors
Christian E Oberkofler
Philipp Dutkowski
Reto Stocker
Reto A Schuepbach
John F Stover
Pierre-Alain Clavien
Markus Béchir
Publication date
01-06-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9068

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