title: Outcomes after liver transplantation in patients achieving a model for end-stage liver disease score of 40 or higher.
abstract: BACKGROUND
  Patients with Model for End-Stage Liver Disease (MELD) scores of 40 or higher are at high risk for liver transplantation. In some regions, the organ donor shortage has resulted in a substantial increase in the number of patients who underwent transplantation with MELD scores of 40 or higher. The objective of this study was to characterize the outcomes of liver transplantation in these patients.
  
  
  METHODS
  A single-center retrospective study evaluating the outcome of liver transplantation in 38 consecutive patients achieving a MELD score of 40 or higher from January 1, 2006, to November 30, 2010, was conducted. Patient and graft survivals and independent risk factors for postoperative death or graft loss were determined.
  
  
  RESULTS
  Kaplan-Meier-based 1-, 2-, and 3-year patient survival rates were 89%, 82%, and 77% with 1-, 2-, and 3-year graft survival rates of 84%, 75%, and 70.3%, respectively. One of three recipients was on a vasopressor before transplantation, and 13% were mechanically ventilated. Renal replacement therapy was used before operation in 90% of the recipients. Postoperative length of stay averaged 38 days. There was a 42% incidence of postoperative bacteremia and an 18% incidence of bile duct stricture within 6 months. Univariate analysis identified admission-to-transplantation time and recipient diabetes as risk factors for graft failure and patient death. Multivariate analysis confirmed recipient diabetes as a risk factor for patient survival and admission-to-transplantation time of more than 15 days as a risk factor for graft survival.
  
  
  CONCLUSIONS
  Acceptable outcomes are achievable after liver transplantation in patients with MELD scores of 40 or higher but come at high pretransplantation and posttransplantation resource utilization.
authors: Division of Hepatobiliary and Pancreatic Surgery and Abdominal Organ Transplantation, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. alexopou@health.usc.edu
authors: Sophoclis
authors: S
authors: Alexopoulos
authors: Lea
authors: L
authors: Matsuoka
authors: Yong
authors: Y
authors: Cho
authors: Elizabeth
authors: E
authors: Thomas
authors: Mohd
authors: M
authors: Sheikh
authors: Maria
authors: M
authors: Stapfer
authors: Kiran
authors: K
authors: Dhanireddy
authors: Linda
authors: L
authors: Sher
authors: Rick
authors: R
authors: Selby
authors: Yuri
authors: Y
authors: Genyk
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult