title: Operative timing of liver transplantation for patients with severe hepatitis.
abstract: BACKGROUND
  Fulminant hepatic failure manifests a rapid onset, serious complications, and a high mortality, but still there is a possibility of recovery. Once the patient is able to pass a crisis, the liver is able to regenerate completely and regain its normal function. Therefore it is of vital importance to determine the eligible timing for transplantation. Premature surgery might result in a loss of the chance of internal medical treatment and misuse of liver resources, whereas delayed surgery might increase the difficulty of treatment in the preoperative period and the possibility of complications and medical expense, which eventually result in decreased rate of success and survival. This problem remains worldwide how to choose the optional timing of operation.
  
  
  METHODS
  Thirty-six patients with severe hepatitis were treated by orthotopic liver transplantation. The distribution of MELD scores in these patients was: 10-19 in 8 patients, 20-29 in 10, 30-39 in 11, and 40 in 7. They were divided into two groups: MELD score <30 and MELD score >or=30. Parameters (1-year survival rate, complications, preoperative use of artificial liver, operative time, volume of bleeding and blood transfusion, and average hospital costs) were examined as prognostic factors after liver transplantation.
  
  
  RESULTS
  The 1-year survival rate of the MELD score <30 group was higher than that of the >or=30 group (77.8% and 33.3%, P=0.007), and the rate of complications in the <30 group was lower (P=0.012). There were no differences in the timing of artificial liver treatment, operative time, operative hemorrhage, and transfusion between the two groups (P=0.742). But the average daily hospital cost in the MELD score >or=30 group was higher (P=0.008).
  
  
  CONCLUSIONS
  This study shows that when the MELD score is <30 it may be the optimal time to perform liver transplantation for patients with severe hepatitis.
authors.affiliation: Institute of Hepatobiliary Surgery, Fuzhou General Hospital, Fuzhou 350025, China.
authors.forename: Qiu-Cheng
authors.initials: QC
authors.lastname: Cai
authors.forename: Yi
authors.initials: Y
authors.lastname: Jiang
authors.forename: Li-Zhi
authors.initials: LZ
authors.lastname: Lv
authors.forename: Huan-Zhang
authors.initials: HZ
authors.lastname: Hu
authors.forename: Xiao-Jin
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Yong-Biao
authors.initials: YB
authors.lastname: Chen
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Chen
authors.forename: Kun
authors.initials: K
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Yang
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Wei
authors.forename: Fan
authors.initials: F
authors.lastname: Pan
authors.forename: Shao-Geng
authors.initials: SG
authors.lastname: Zhang
authors.forename: Hua
authors.initials: H
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors