Postoperative resource utilization and survival among liver transplant recipients with Model for End-stage Liver Disease score ≥40: a retrospective cohort study

Introduction

Cirrhotic patients with Model for End-stage Liver Disease (MELD) score ≥40 have high risk of death without liver transplant (LT) [1]. This study aimed to evaluate these patients' outcomes after transplant.

Methods

The retrospective cohort included 519 adult cirrhotic patients who underwent LT at one Canadian center between 2002 and 2012. Primary exposure was severity of end-stage liver disease measured by MELD score at transplant (≥40 vs. <40) [2]. The primary outcome was duration of first ICU stay after LT [3]. Secondary outcomes were duration of first hospital stay after LT, rate of ICU readmission, re-transplant rate, and survival rates.

Results

On the day of LT, 5% (28/519) of patients had a MELD score ≥40. These patients had longer first ICU stay after LT (14 vs. 2 days; P > 0.001). MELD score ≥40 at transplant was independently associated with first ICU stay after transplant ≥10 days (OR, 3.21). These patients had longer first hospital stay after LT (45 vs. 18 days; P < 0.001); however, there was no significant difference in the rate of ICU readmission (18% vs. 22%; P = 0.58) or re-transplant rate (4% vs. 4%; P = 1.00). Cumulative survival at 1 month, 3 months, 1 year, 3 years, and 5 years was 98%, 96%, 90%, 79%, and 72%, respectively. There was no significant difference in cumulative survival stratified by MELD score ≥40 versus <40 at transplant (P = 0.59).

Conclusion

Cirrhotic patients with MELD score ≥40 at transplant utilize greater postoperative health resources; however, they derive similar long-term survival benefit with LT.