Furthermore, the following clinical data were collected: underlying liver disease, Child-Turcotte-Pugh classification, MELD score uncorrected and corrected for hepatocellular carcinoma according to the regulation of the government, incidence of hepatorenal syndrome directly before transplantation (according to the definition described by Arroyo and colleagues and Salerno and colleagues ), and diabetes mellitus, electively or high urgent listing, pretransplant location (home, normal hospital ward or ICU) and finally the need for pretransplant RRT. For analysis the last available values directly before transplantation were included. Creatinine values of the patients with renal replacement therapy (RRT) prior to transplantation were excluded from the calculation. Īs baseline characteristics we analyzed age, gender, height, weight, body mass index, creatinine, hematocrit and platelet count. We defined extended donor criteria (marginal grafts) as either age 65 years or older or cold ischemia time of 720 minutes or longer or biopsy-proven steatosis (micro- or macrovascular in ≥60% of hepatocytes or ≥30% macrovascular steatosis). Following approval by the local ethics committee, all patients gave written informed consent before transplantation for postoperative data analysis.
In order to prevent discrimination of patients on the waiting list with a hepatic tumor or a metabolic and cholestatic disease, those patients received exceptional points, resulting in higher (corrected) MELD scores than the calculated laboratory (uncorrected) MELD would be. This score is a reliable parameter to predict mortality of liver transplant candidates on the waiting list. Patients were transplanted according to the MELD score, which is based on recipient kidney function, coagulation time and serum bilirubin, and ranges from 7 to 40. Thus, we included data of 151 liver transplantations in 144 patients over six years with a median follow up of 27.0 months into our study. Two of them underwent retransplantation twice and three patients only once, and two cases out of this seven were electively listed and five patients were high urgent listed. Five of these patients underwent seven retransplantations. We included in the study a total of 144 consecutive patients who underwent liver transplantation between 1 January, 2003 and 31 December, 2008 in our transplant center. Therefore, data from all consecutive liver transplants performed in our institution over six years, from 1 January 2003 to 31 December 2008, were analyzed. Furthermore, the study was undertaken to determine the major ICU problems in such patients and to outline and predict major clinical risk factors regarding length of stay in the ICU and mortality. In this study we addressed the question of whether MELD score affects postoperative morbidity, represented by an increased length of stay in the ICU and mortality in patients after liver transplantation. Therefore, it is essential to identify and modify risk factors to improve postoperative ICU management. The current challenge is to optimize outcome with limited resources, because liver transplantation remains financially expensive with incremental costs when postoperative complications occur. Although liver transplantation has been the sole treatment of patients with ESLD for over 20 years, only limited data are available addressing the intensive care management and complications of this patient population. įurthermore, the unique pathophysiology of end-stage liver disease (ESLD) has important implications on critical care treatment after transplantation. There are reports of reduced survival in groups with high MELD scores, but also reports of no influence of MELD score on survival. The impact of MELD score on postoperative mortality remains elusive. This new policy stratifies the patients based on their risk of death while on the waiting list. Since February 2002, the United Network for Organ Sharing introduced a new allocation policy for cadaveric liver transplants, based on the model for end-stage liver disease (MELD) score. The USA and Europe used prioritization systems based on waiting time and on the parameters of the Child-Turcotte-Pugh score. Fair allocation of donor livers to patients with end-stage liver disease is a difficult task.
As liver transplantation has become a universally accepted treatment for end-stage liver disease, the number of patients accumulating on the waiting list has gradually outweighed the scarce resources of available organs. Liver transplantation is still a complex and cost-intensive procedure and the results are influenced by many interrelated factors.
0 kommentar(er)
