title: Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients.
abstract: BACKGROUND
  The impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival.
  
  
  METHODS
  We retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters.
  
  
  RESULTS
  This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio [OR] 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2).
  
  
  CONCLUSIONS
  This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity.
authors.affiliation: Department of Visceral- and Transplantation Surgery, University Hospital of Zurich, Raemistrasse 100, Zürich 8091, Switzerland. christian.oberkofler@usz.ch
authors.forename: Christian E
authors.initials: CE
authors.lastname: Oberkofler
authors.forename: Philipp
authors.initials: P
authors.lastname: Dutkowski
authors.forename: Reto
authors.initials: R
authors.lastname: Stocker
authors.forename: Reto A
authors.initials: RA
authors.lastname: Schuepbach
authors.forename: John F
authors.initials: JF
authors.lastname: Stover
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.forename: Markus
authors.initials: M
authors.lastname: Béchir
mesh_terms: D058625:End Stage Liver Disease / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology