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Canadian Journal of Gastroenterology and Hepatology
Volume 29, Issue 4, Pages 185-191
http://dx.doi.org/10.1155/2015/954656
Original Article

Postoperative Resource Utilization and Survival among Liver Transplant Recipients with Model for End-Stage Liver Disease Score ≥40: A Retrospective Cohort Study

Filipe S Cardoso,1 Constantine J Karvellas,1,2 Norman M Kneteman,3 Glenda Meeberg,4 Pedro Fidalgo,1 and Sean M Bagshaw1

1Division of Critical Care Medicine, Alberta Health Services, Edmonton, Alberta, Canada
2Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, Edmonton, Alberta, Canada
3Division of Transplantation, Department of Surgery, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
4Liver Transplant Program, Alberta Health Services, Edmonton, Alberta, Canada

Received 16 April 2014; Accepted 12 February 2015

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.