Liver Transplantation for MELD-Score 40 Patients: Preliminary Results and Single Center Experience.

Objective: To identify factors influencing the survival of liver transplanted patients with Model-for-End-Stage-Liver-Disease (MELD)-Score of 40. Summary Background Data:Organ shortage and the related waiting-list mortality have led to changes in the allocation criteria and introduction of the MELD-Score in the Eurotransplant Era. The highest medical urgency represents the current allocation principle for liver transplantation (LT). Patients with MELD-Score 40 have a 3-month survival probability of almost 0% without LT. Patients and Methods: Data of all adult patients transplanted in a 3.5-year period with a labMELD-score 40 were reviewed. Recipients with acute liver failure, high urgency listed patients for re-transplantation or patients receiving live donor LT were excluded. All operations were performed using standard surgical techniques. Donor and recipient perioperative characteristics, operative details, treatment-related complications and pathological findings were analyzed. Statistical analysis encompassed Kaplan-Meier analysis/log-rank test as well as univariate and multivariable Cox proportional hazard regression analyses. Results: Thirty patients were considered. The survival rate regarding the first 3, 6 and 9 months was 53% respectively and 50% after one year. 3-year patient survival was 50%. A re-transplantation has been performed in 4 cases. Graft survival was 57% at 3, 6, and 9 months, and 53% at one year, respectively. Forty-three variables were evaluated for prognostic significance. Multivariable analysis revealed preoperative dialysis (p=0.0246) and portal vein thrombosis (PVT) (p=0.0231) to be independent prognostic factors for patient survival. A point scoring system was determined as follows: patients without PVT: patients with PVT=0:1 points; patients without pre-LT dialysis: patients with pre-LT dialysis=0:1 points. The model reached statistical significance (p=0.0007). 3-, and 12-months survival for scores 0, 1 and 2 were 72% and 72%, 51% and 42%, and 0%, respectively. Conclusions: According to our study coexistence of preoperative dialysis and PVT represents a clear contraindication for LT regarding MELD-score 40 patients.