title: Single-Center Experience on Liver Transplantation for Model for End-Stage Liver Disease Score 40 Patients.
abstract: Organ shortage and waiting list mortality have led to changes in the allocation policy in Eurotransplant.
  
  
  
  To identify factors influencing the survival of liver transplanted patients with model for end-stage liver disease (MELD) score of 40.
  
  
  
  Data of listed adult patients who reached a MELD score 40 in the period 12/2006-06/2010 were reviewed. Donor/graft and recipient characteristics, and operative details were analyzed. Statistical analysis encompassed Kaplan-Meier analysis/log-rank test as well as univariate and multivariable regression analyses.
  
  
  
  Forty-eight patients achieved a MELD score 40. Thirty patients were transplanted, whereas 18 patients were not. Three-month, 1-year, and 5-year patient and graft survival for transplanted patients was 53, 50, and 47 %, respectively. Three-month and 1-year survival after listing was 11 and 6 % for not transplanted patients, respectively (p < 0.0001). Multivariable analysis revealed pre-operative dialysis (p = 0.0246) and portal vein thrombosis (PVT) (p = 0.0231) to be independent prognostic factors for post-transplant patient survival. A point scoring system was created, which reached statistical significance (p = 0.0007). One-year and 5-year survival for scores 0, 1, and 2 were 72 and 64, 42 and 42 and 0 %, respectively. There was no statistical difference in transplantation costs between patients who survived or died (p = 0.1578).
  
  
  
  At our center, coexistence of pre-operative dialysis and PVT represents a clear contraindication for LT regarding MELD score 40 patients.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany. georgios.sotiropoulos@uni-due.de.
authors.forename: Georgios C
authors.identifier: 0000-0003-3236-6579
authors.initials: GC
authors.lastname: Sotiropoulos
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Vernadakis
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors.forename: Dieter P
authors.initials: DP
authors.lastname: Hoyer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Gallinat
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D018579:Patient Selection; D011169:Portal Vein; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000379:methods; D020246:Venous Thrombosis / Q000453:epidemiology*; D055815:Young Adult
keywords: Hospital mortality; Liver transplantation; MELD score; Sickest first policy; Survival benefit