title: Postoperative resource utilization and survival among liver transplant recipients with Model for End-stage Liver Disease score ≥ 40: A retrospective cohort study.
abstract: BACKGROUND
  Cirrhotic patients with Model for End-stage Liver Disease (MELD) score ≥ 40 have high risk for death without liver transplant (LT).
  
  
  OBJECTIVE
  To evaluate these patients' outcomes after LT.
  
  
  METHODS
  The present study analyzed a retrospective cohort of 519 cirrhotic adult patients who underwent LT at a single Canadian centre between 2002 and 2012. Primary exposure was severity of liver disease measured by MELD score at LT (≥ 40 versus < 40). Primary outcome was duration of first intensive care unit (ICU) stay after LT. Secondary outcomes were duration of first hospital stay after LT, rate of ICU readmission, re-LT and survival rates.
  
  
  RESULTS
  On the day of LT, 5% (28 of 519) of patients had a MELD score ≥ 40. These patients had longer first ICU stays after LT (14 versus two days; P < 0.001). MELD score ≥ 40 at LT was independently associated with first ICU stay after LT ≥ 10 days (OR 3.21). These patients had longer first hospital stays after LT (45 versus 18 days; P < 0.001); however, there was no significant difference in the rate of ICU readmission (18% versus 22%; P = 0.58) or re-LT rate (4% versus 4%; P = 1.00). Cumulative survival at one month, three months, one year, three years and five years was 98%, 96%, 90%, 79% and 72%, respectively. There was no significant difference in cumulative survival stratified according to MELD score ≥ 40 versus < 40 at LT (P = 0.59).
  
  
  CONCLUSIONS
  Cirrhotic patients with MELD score ≥ 40 at LT utilize greater postoperative health resources; however, they derive similar long-term survival benefit from LT.
authors.forename: Filipe S
authors.initials: FS
authors.lastname: Cardoso
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.forename: Norman M
authors.initials: NM
authors.lastname: Kneteman
authors.forename: Glenda
authors.initials: G
authors.lastname: Meeberg
authors.forename: Pedro
authors.initials: P
authors.lastname: Fidalgo
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome