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When is a liver transplant futile?
Author(s) -
Perkins James D.
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21515
Subject(s) - medicine , liver transplantation , creatinine , dialysis , liver disease , orthotopic liver transplantation , mechanical ventilation , gastroenterology , transplantation , model for end stage liver disease
Background Recently, the model of end‐stage liver disease (MELD) index has been used to select patients with acute liver failure (ALF) for transplantation. By the time the indication for orthotopic liver transplantation (OLT) is defined, the patient's clinical status may worsen. Objective In this study, MELD was used to define patients beyond OLT. Methods Among adult patients ALF was responsible for 17 OLT. Their medical records were reviewed to calculate the MELD score just before the OLT. MELD of the deceased patients after OLT (group 1, n = 8), was compared with the MELD score of living recipients (group 2, n = 9). Creatinine level, need for dialysis, use of vasoactive amines, and mechanical ventilation before OLT were also analyzed in these groups. A significant difference was defined when P <.05. Results The mean MELD score ± SD was 51.86 ± 12.3 for group 1, and 38.47 ± 7.1 for group 2 ( P = .02). There was no difference between the creatinine values for patients in the 2 groups ( P = .20). Also, the use of vasoactive amines or the need of dialysis before OLT were not different ( P = .12 and P = .25, respectively). Group 1 was more frequently under mechanical ventilation, and showed a 4.29 relative risk for death after OLT. Conclusion MELD score could be useful to define the prognosis of OLT among patients with ALF.