From the Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, B.C. (Bleszynski, Punnen, Desai Chartier-Plante, Segedi, Scudamore, Chung, Buczkowski, Kim); the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, B.C. (Hussaini); and the Department of Medicine, Division of Gastroenterology, University of British Columbia Vancouver, B.C. (Marquez, Yoshida, Jayakumar).
From the Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, B.C. (Bleszynski, Punnen, Desai Chartier-Plante, Segedi, Scudamore, Chung, Buczkowski, Kim); the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, B.C. (Hussaini); and the Department of Medicine, Division of Gastroenterology, University of British Columbia Vancouver, B.C. (Marquez, Yoshida, Jayakumar)
Can J Surg. 2022 Jul 5;65(4):E425-E439. doi: 10.1503/cjs.025520. Print 2022 Jul-Aug.
The frequency with which patients with high Model for End-Stage Liver Disease (MELD) scores undergo liver transplantation has been increasing. Canadian literature regarding the outcomes of liver transplantation in recipients with high MELD scores is limited. The primary objective of this study was to assess patient and graft survival among recipients with high (> 35) and low (≤ 35) MELD scores. Secondary objectives were to potentially identify independent predictors of graft failure and patient mortality.
We conducted a retrospective chart review of patients undergoing liver transplantation at a single Canadian centre from 2012 to 2017.
A total of 332 patients were included in the study: 280 patients had a MELD score of 35 or lower, and 52 had a MELD score above 35. Patients with high MELD scores had higher rates of pretransplant acute kidney injury and dialysis ( < 0.001), admission to the intensive care unit (ICU) or intubation ( < 0.001), intraoperative blood product transfusions ( < 0.001) and post-transplantation acute kidney injury and dialysis ( < 0.001), as well as longer ICU ( < 0.001) and hospital stays ( = 0.002). One- and 3-year patient survival in recipients with MELD scores of 35 or lower was 93.1% and 84.9% versus 85.0% and 80.0% in recipients with MELD scores above 35 ( = 0.37). One- and 3-year graft survival in recipients with MELD scores of 35 or lower was 91.7% and 90.9% versus 77.2% and 72.8% in recipients with MELD scores above 35 ( < 0.001). Prior liver transplant was an independent predictor of patient mortality, and no independent predictors of graft failure were identified. When MELD was replaced with D-MELD (donor age × recipient MELD), it predicted graft failure but not patient survival.
No difference in patient mortality was found between MELD groups. Graft survival was significantly lower in recipients with MELD scores above 35. D-MELD may potentially be used as an adjunct in determining risk of graft failure in recipients with high MELD scores.
高终末期肝病模型（MELD）评分患者接受肝移植的频率一直在增加。加拿大关于高 MELD 评分患者肝移植结局的文献有限。本研究的主要目的是评估高（>35）和低（≤35）MELD 评分患者的患者和移植物存活率。次要目标是确定移植物失败和患者死亡的独立预测因素。
我们对 2012 年至 2017 年在加拿大一家中心接受肝移植的患者进行了回顾性图表审查。
共有 332 例患者纳入研究：280 例患者 MELD 评分为 35 或更低，52 例患者 MELD 评分高于 35。MELD 评分较高的患者有更高的术前急性肾损伤和透析发生率（<0.001）、入住重症监护病房（ICU）或插管（<0.001）、术中输血（<0.001）和移植后急性肾损伤和透析（<0.001）以及 ICU（<0.001）和住院时间更长（=0.002）。MELD 评分 35 或更低的患者 1 年和 3 年的患者存活率分别为 93.1%和 84.9%，而 MELD 评分高于 35 的患者分别为 85.0%和 80.0%（=0.37）。MELD 评分 35 或更低的患者 1 年和 3 年的移植物存活率分别为 91.7%和 90.9%，而 MELD 评分高于 35 的患者分别为 77.2%和 72.8%（<0.001）。既往肝移植是患者死亡的独立预测因素，而移植物失败的独立预测因素未被发现。当 MELD 被 D-MELD（供体年龄×受体 MELD）替代时，它可以预测移植物失败，但不能预测患者存活。
MELD 组之间的患者死亡率无差异。MELD 评分较高的患者移植物存活率明显较低。D-MELD 可能可作为预测高 MELD 评分患者移植物失败风险的辅助工具。
