title: Waiting time, not donor-risk-index, is a major determinant for beneficial outcome after liver transplantation in high-MELD patients.
abstract: BACKGROUND
  Due to the increasing donor shortage, patients undergo liver transplantation actually mostly with high MELD-scores. In this study, we analyze high-MELD patients who underwent liver transplantation at a german single center.
  
  
  METHODS
  Since implementation of the MELD-score within the Eurotransplant region (December 2006) up to May 2011, 45 patients with a lab-MELD-score ≥ 36 underwent liver transplantation at our center. We correlated the 1-year-survival with donor data (especially the donor risk index, DRI), the time interval from reaching a lab-MELD-score ≥ 36 up to liver transplantation and the recipient's state prior transplantation.
  
  
  RESULTS
  The overall 1-year-survival in our cohort is 68,8%. Waiting time of survivors was significantly shorter compared to non-survivors (MedianSurvivors: 2 days vs. MedianNon-survivors: 4 days; p=0.049). DRI showed no significant differences between both groups. Furthermore, the recipient's state prior transplantation (dialysis, mechanical ventilation, catecholamines) showed no significant association with the outcome.
  
  
  CONCLUSIONS
  The outcome after liver transplantation in high-MELD patients is worse compared to that of patients with a marked lower MELD-score. Especially the time interval between reaching a lab-MELD score ≥ 36 to the transplantation is a major determinant for survival. Since the DRI is not associated with a worsened outcome, transplantation centers should accept even marginal organs for high-MELD patients to keep the waiting time as short as possible.
authors.affiliation: Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany. falk.rauchfuss@med.uni-jena.de
authors.forename: Falk
authors.initials: F
authors.lastname: Rauchfuss
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zidan
authors.forename: Hubert
authors.initials: H
authors.lastname: Scheuerlein
authors.forename: Yves
authors.initials: Y
authors.lastname: Dittmar
authors.forename: Astrid
authors.initials: A
authors.lastname: Bauschke
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
mesh_terms: D058625:End Stage Liver Disease / Q000601:surgery; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists