title: Risk factors for short- and long-term mortality in liver transplant recipients with MELD score ≥30.
abstract: BACKGROUND
  After introduction of MELD-based allocation in Germany, decreased waiting list mortality and increased mortality after transplantation have been reported.
  
  
  METHODS
  This study compares relevant outcome parameters in patients with high MELD ≥30 versus lower MELD scores in a retrospective analysis including 454 consecutively performed liver transplantations in adults (age >16 years) at Hannover Medical School between 01/01/2007 and 31/12/2012 and a follow-up until 31/12/2013. Multivariable risk-adjusted models were applied to identify independent risk factors for 90-day and long-term mortality.
  
  
  RESULTS
  MELD score ≥30 (n=117; 26.1%) was an independent risk factor for 90-day mortality (p=0.004, odds ratio: 3.045, 95% CI 1.439-6.498) and long-term mortality (p=0.016, hazard ratio: 1.620, 95% CI 1.095-2.396) and was associated with significantly longer hospital and intensive care unit stays (p<0.001), and death occurred in more cases earlier after transplantation (90-day mortality 21.6% vs. 13.0%; p=0.029). Portal vein thrombosis at transplantation was significantly associated with 90-day mortality after transplantation in patients with MELD scores ≥30 (p=0.041), but this was not the case for patients with MELD scores <30, although portal vein thrombosis was equally frequent in individuals of both groups (3.0% vs. 3.4%, p=0.824).
  
  
  CONCLUSIONS
  Results of this study suggest that liver transplant recipients with portal vein thrombosis at transplantation should be transplanted before reaching a MELD score ≥30.
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Alexander
authors: A
authors: Kaltenborn
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Catharina
authors: C
authors: Hartmann
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Ricardo
authors: R
authors: Salinas
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Wolf
authors: W
authors: Ramackers
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Moritz
authors: M
authors: Kleine
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Florian W R
authors: FW
authors: Vondran
authors: Staff Office of Quality Management in Clinical Research, Hannover Medical School, Hannover, Germany.
authors: Marc
authors: M
authors: Barthold
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Frank
authors: F
authors: Lehner
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Jürgen
authors: J
authors: Klempnauer
authors: Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany.
authors: Harald
authors: H
authors: Schrem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014850:Waiting Lists; D055815:Young Adult