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Single-Center Experience on Liver Transplantation for Model for End-Stage Liver Disease Score 40 Patients

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Abstract

Background

Organ shortage and waiting list mortality have led to changes in the allocation policy in Eurotransplant.

Aim

To identify factors influencing the survival of liver transplanted patients with model for end-stage liver disease (MELD) score of 40.

Patients and Methods

Data of listed adult patients who reached a MELD score 40 in the period 12/2006–06/2010 were reviewed. Donor/graft and recipient characteristics, and operative details were analyzed. Statistical analysis encompassed Kaplan–Meier analysis/log-rank test as well as univariate and multivariable regression analyses.

Results

Forty-eight patients achieved a MELD score 40. Thirty patients were transplanted, whereas 18 patients were not. Three-month, 1-year, and 5-year patient and graft survival for transplanted patients was 53, 50, and 47 %, respectively. Three-month and 1-year survival after listing was 11 and 6 % for not transplanted patients, respectively (p < 0.0001). Multivariable analysis revealed pre-operative dialysis (p = 0.0246) and portal vein thrombosis (PVT) (p = 0.0231) to be independent prognostic factors for post-transplant patient survival. A point scoring system was created, which reached statistical significance (p = 0.0007). One-year and 5-year survival for scores 0, 1, and 2 were 72 and 64, 42 and 42 and 0 %, respectively. There was no statistical difference in transplantation costs between patients who survived or died (p = 0.1578).

Conclusions

At our center, coexistence of pre-operative dialysis and PVT represents a clear contraindication for LT regarding MELD score 40 patients.

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Abbreviations

BMI:

Body mass index

CIT:

Cold ischemia time

γGT:

Gamma glutamyltransferase

EAD:

Early allograft dysfunction

GvHD:

Graft versus Horst Disease

HBV:

Viral hepatitis B

HCV:

Viral hepatitis C

ICU:

Intensive care unit

INR:

International normalized ratio

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

NAS:

Nonanastomotic strictures

PVT:

Portal vein thrombosis

PNF:

Primary nonfunction

UNOS:

United Network for Organ Sharing

WIT:

Warm ischemia time

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Acknowledgments

The authors want to thank Mr. Jürgen Tacken, Mr. Achim Konietzko, and Ms. Heidrun Kuhlmann for their essential help by data sampling and updating.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany

    Georgios C. Sotiropoulos, Spyridon Vernadakis, Andreas Paul, Dieter P. Hoyer, Fuat H. Saner & Anja Gallinat

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  1. Georgios C. Sotiropoulos
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  2. Spyridon Vernadakis
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  3. Andreas Paul
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Correspondence to Georgios C. Sotiropoulos.

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Sotiropoulos, G.C., Vernadakis, S., Paul, A. et al. Single-Center Experience on Liver Transplantation for Model for End-Stage Liver Disease Score 40 Patients. Dig Dis Sci 61, 3346–3353 (2016). https://doi.org/10.1007/s10620-016-4274-3

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