Perioperative Findings and Postoperative Complications in Living Donor Liver Transplantation Recipients with High MELD Scores

Year 2023, Volume: 22 Issue: 3, 150 - 154, 22.12.2023

Ender Anılır Feyza Sönmez Topcu Alihan Oral Emrah Şahin Abuzer Dirican Bülent Ünal

https://doi.org/10.17941/agd.1405010

Cited By: 1

Abstract

Background and Aims: We aimed to investigate the effect of the high MELD score on perioperative recipient/graft ischemia times and postoperative complications. Materials and Method: One hundred and seventy-two patients who underwent living-donor liver transplantation for end stage liver cirrhosis were included in the study. The patients were grouped and examined according to their MELD score under and above 20. Anhepatic phase, cold ischemia time, operation time, blood product transfusion, total hospital and intensive care unit staying time rates, biliary complications, hepatic vein thrombosis, portal vein thrombosis, postoperative hemorrhage, sepsis, and primary graft dysfunction were analyzed statistically. Results: Cold ischemia time (p = 0.046) was statistically longer in patients with MELD >20. A result very close to the statistically significant P value regarding perioperative blood transfusion was obtained. Conclusion: Cold ischemia time increases with increasing MELD. The MELD score must be taken into consideration when preparing the patient and making a treatment plan.

Keywords

MELD, liver, transplant, cold ischemia, complication

Ethical Statement

This study was approved by the İstanbul Aydın University Non-invasive Clinical Research Ethics Committee with decision number 2023/114.

MELD Skoru Yüksek Canlı Vericili Karaciğer Nakli Alıcılarında Perioperatif Bulgular ve Postoperatif Komplikasyonlar

Abstract

Giriş ve Amaç: Yüksek MELD skorunun perioperatif alıcı/greft iskemi süreleri ve postoperatif komplikasyonlar üzerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya, son dönem karaciğer sirozu nedeniyle canlı vericiden karaciğer nakli yapılan 172 hasta dahil edildi. Hastalar MELD skorları 20'nin altında ve üstünde olanlara göre gruplandırılarak incelendi. Anhepatik faz, soğuk iskemi süresi, operasyon süresi, kan ürünü transfüzyonu, toplam hastane ve yoğun bakım ünitesinde kalış süresi, safra komplikasyonları, hepatik ven trombozu, portal ven trombozu, postoperatif kanama, sepsis ve primer greft disfonksiyonu istatistiksel olarak analiz edildi. Bulgular: MELD >20 olan hastalarda soğuk iskemi süresi (p = 0,046) istatistiksel olarak daha uzundu. Perioperatif kan transfüzyonuna ilişkin istatistiksel olarak anlamlı P değerine çok yakın bir sonuç elde edildi. Sonuç: MELD arttıkça soğuk iskemi süresi de artmaktadır. Hasta hazırlanırken ve tedavi planı yapılırken MELD skoru dikkate alınmalıdır.

Keywords

MELD, karaciğer, nakil, soğuk iskemi, komplikasyon

References

• 1. Acar Ş, Akyıldız M, Gürakar A, Tokat Y, Dayangaç M. Delta MELD as a predictor of early outcome in adult-to-adult living donor liver transplantation. Turk J Gastroenterol 2020;31:782-9.
• 2. Axelrod DA, Dzebisashvili N, Lentine KL, et al. Variation in biliary complication rates following liver transplantation: implications and outcome. Am J Transplant 2015;15:170-9.
• 3. Hung HC, Lee JC, Wang YC, et al. Living-Donor Liver Transplantation for Hepatocellular Carcinoma: Impact of the MELD Score and Predictive Value of NLR on Survival. Curr Oncol 2022;29:3881-93.
• 4. Stratigopoulou P, Paul A, Hoyer DP, et al. High MELD score and extended operating time predict prolonged initial ICU stay after liver transplantation and influence the outcome. PLoS One 2017;12:e0174173.
• 5. Xia VW, Du B, Braunfeld M, et al. Preoperative characteristics and intraoperative transfusion and vasopressor requirements in patients with low vs. high MELD scores. Liver Transpl 2006;12:614-20.
• 6. Batista TP, Sabat BD, Melo PS, et al. Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil. Clinics (Sao Paulo) 2011;66:57-64.
• 7. Cardoso FS, Karvellas CJ, Kneteman NM, et al. Postoperative resource utilization and survival among liver transplant recipients with Model for End-stage Liver Disease score ≥ 40: A retrospective cohort study. Can J Gastroenterol Hepatol 2015;29:185-91.
• 8. Bleszynski MS, Punnen S, Desai S, et al. Outcomes of liver transplant recipients with high MELD scores: an experience from a Canadian centre. Can J Surg 2022;65:E425-E439.
• 9. Kong L, Lv T, Jiang L, Yang J, Yang J. Outcomes of hemi- versus whole liver transplantation in patients from mainland china with high model for end-stage liver disease scores: a matched analysis. BMC Surg 2020;20:290.
• 10. González Martínez S, Molina Raya A, Becerra Massare A, et al. Liver Transplantation in Recipients With High Model for End-stage Liver Disease Score. Transplant Proc 2018;50:595-7.
• 11. Chok KSh, Chan SC, Fung JY, et al. Survival outcomes of right-lobe living donor liver transplantation for patients with high Model for End-stage Liver Disease scores. Hepatobiliary Pancreat Dis Int 2013;12:256-62.
• 12. Oberkofler CE, Dutkowski P, Stocker R, et al. Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients. Crit Care 2010;14:R117.
• 13. Foxton MR, Al-Freah MA, Portal AJ, et al. Increased model for end-stage liver disease score at the time of liver transplant results in prolonged hospitalization and overall intensive care unit costs. Liver Transpl 2010;16:668-77.
• 14. Schlegel A, Linecker M, Kron P, et al. Risk Assessment in High- and Low-MELD Liver Transplantation. Am J Transplant 2017;17:1050-63.
• 15. Sun HY, Cacciarelli TV, Singh N. Identifying a targeted population at high risk for infections after liver transplantation in the MELD era. Clin Transplant 2011;25:420-5.
• 16. Selzner M, Kashfi A, Cattral MS, et al. Live donor liver transplantation in high MELD score recipients. Ann Surg 2010;251:153-7.
• 17. Sundaram V, Jones DT, Shah NH, et al. Posttransplant biliary complications in the pre- and post-model for end-stage liver disease era. Liver Transpl 2011;17:428-35.
• 18. Wernly B, Lichtenauer M, Franz M, et al. Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance. PLoS One 2017;12:e0170987.