MELD score and blood product requirements during liver transplantation: no link.
BACKGROUND
Orthotopic liver transplantation has been traditionally associated with major blood loss and the need for allogenic blood product transfusions. In recent years, improvements in surgical and anesthetic techniques have greatly decreased the amount of blood products transfused. We have published a median of 0 for all intraoperative blood products transfused. Some authors argue that these results could be possible merely because of the relatively healthy cohort in terms of model of end-stage liver disease (MELD) score. The MELD score could be adjusted by some conditions (hepatocellular carcinoma, hemodialysis, hepatopulmonary syndrome, and amyloidosis) and was not adjusted in these series. The goal of this work was to verify the MELD score according to US standards and to find any link between the MELD score and the transfusion rate.


METHODS
Three hundred fifty consecutive liver transplantations were studied. The MELD score was adjusted according to US standards. Patients were divided into two groups according to the median of the MELD score. Blood loss and transfusion rate were determined for these two groups. Logistic regression models were used to find any link with transfusion of red blood cell (RBC) units.


RESULTS
The MELD score before adjusting was 19+/-9 and 22+/-10 after. A mean of 0.5+/-1.3 RBC units/patient intraoperative were transfused with 80.6% of cases without any blood products. There was no difference for the blood loss (999+/-670 mL vs. 1017+/-885 mL) or the transfusion rate (0.4+/-1.2 vs. 0.5+/-1.4 RBC/patient) between two groups of MELD (<21 or >or=21) or any of its component (creatinine, bilirubin, and international normalized ratio). The logistic regression analysis found that only two variables were linked to RBC transfusion; starting hemoglobin value and phlebotomy.


CONCLUSIONS
In this series, the MELD score was as high as US series and did not predict blood losses and blood product requirement during liver transplantation. If the MELD system has to be implemented to prioritize orthotopic liver transplantation, it should be revisited, and the starting hemoglobin value should be added to the equation.
Massicotte
Luc
L
Department of Anesthesiology, Centre hospitalier de l'Université de Montréal (CHUM), Hôpital St-Luc, Montreal, QC, Canada. luc.massicotte@umontreal.ca
Beaulieu
Danielle
D
Roy
Jean-Denis
JD
Marleau
Denis
D
Vandenbroucke
Frank
F
Dagenais
Michel
M
Lapointe
Réal
R
Roy
André
A
D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002496:Central Venous Pressure; D003404:Creatinine / Q000097:blood; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D007432:Intraoperative Period; D017093:Liver Failure / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014850:Waiting Lists
D003404:Creatinine