Operative timing of liver transplantation for patients with severe hepatitis.
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.
Cai
Qiu-Cheng
QC
Institute of Hepatobiliary Surgery, Fuzhou General Hospital, Fuzhou 350025, China.
Jiang
Yi
Y
Lv
Li-Zhi
LZ
Hu
Huan-Zhang
HZ
Zhang
Xiao-Jin
XJ
Chen
Yong-Biao
YB
Chen
Shao-Hua
SH
Zhang
Kun
K
Yang
Fang
F
Wei
Wei-Ming
WM
Pan
Fan
F
Zhang
Shao-Geng
SG
Lin
Hua
H
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