Preoperative characteristics and intraoperative transfusion and vasopressor requirements in patients with low vs. high MELD scores.
Recent changes in organ allocation based on the model for end-stage liver disease (MELD) prioritize the most ill patients on the waiting list for liver transplantation. While patients undergoing liver transplantation in the MELD era are more acutely ill, the impact of the policy changes on perioperative management has not been completely assessed. We retrospectively reviewed the records of 124 primary adult liver transplant patients. Patients were divided into low (< or = 30) and high MELD (>30) score groups. Preoperative characteristics and intraoperative management were compared between the 2 groups. Patients with high MELD scores had lower baseline hematocrit and fibrinogen levels and were more likely to require ventilatory and vasopressor support before transplantation. Intraoperative transfusion requirements and use of vasopressors were also significantly increased in patients with high MELD scores compared to patients with low MELD scores. In conclusion, these data suggest that pretransplant MELD scores provide important information for perioperative management of patients undergoing liver transplantation.
Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1778, USA. vxia@mednet.ucla.edu
Victor W
VW
Xia
Bin
B
Du
Michelle
M
Braunfeld
Gundappa
G
Neelakanta
Ke-Qin
KQ
Hu
Hamid
H
Nourmand
Philip
P
Levin
Ronald
R
Enriquez
Jonathan R
JR
Hiatt
R Mark
RM
Ghobrial
Douglas G
DG
Farmer
Ronald W
RW
Busuttil
Randolph H
RH
Steadman
D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D015897:Comorbidity; D005260:Female; D006292:Health Priorities; D006801:Humans; D007430:Intraoperative Care; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015424:Reperfusion; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents