Risk factors for in-hospital mortality of patients with high model for end-stage liver disease scores following living donor liver transplantation.
BACKGROUND
Living donor liver transplantation (LDLT) for patients with high model for end-stage liver disease (MELD) scores is controversial due to its poor outcome. However, there is little information regarding which factor would negatively impact the outcome of patients with high MELD scores. The aim of this study was to identify factors associated with the in-hospital mortality of patients with high MELD scores after LDLT.


METHODS
All patients with an MELD scores ≥ 20 who received LDLT from 2005 to 2011 were recruited for the present study. Pre- and intra-operative variables were retrospectively and statistically analyzed.


RESULTS
A total of 61 patients were included in the current study. The overall 3-month survival rate was 82% for patients with high MELD scores. Preoperative renal dysfunction, hyponatremia, starting albumin level < 2.8 g/dL, preoperative renal replacement for severe renal failure, anhepatic period > 100 minutes and intraoperative red blood cell (RBC) transfusion ≥ 10 units were identified as potential risk factors by univariate analysis. However, only hyponatremia, preoperative dialysis and massive RBC transfusion were independent risk factors in a multivariate analysis. The 3-month survival rates of patients with two or more independent risk factors and patients with none or one risk factor were 91 and 25%, respectively. A significant difference was observed (P < 0.001).


CONCLUSIONS
Hyponatremia, preoperative dialysis and massive RBC transfusion were related to poor outcome for sicker patients. Patients with two or more of the above-mentioned risk factors and high MELD scores may exhibit extremely poor short-term survival.
Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China.
Chuan
C
Li
Tian-Fu
TF
Wen
Lu-Nan
LN
Yan
Bo
B
Li
Jia-Ying
JY
Yang
Ming-Qing
MQ
Xu
Wen-Tao
WT
Wang
Yong-Gang
YG
Wei
D000328:Adult; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007010:Hyponatremia / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult