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A. TRANSPLANT/LIVER SURGERY 001 THE MELD SCORE HAS A NEGATIVE IMPACT IN PATIENT SURVIVAL ALTER LIVER TRANSPLANTATION P. CUEVAS-ESTANDÍA* *CENTRO DE ENFERMEDADES HEPÁTICAS, HOSPITAL SAN JOSÉ-TEC DE MONTERREY, MONTERREY, NUEVO LEÓN, MÉXICO. Introduction: The MELD score has been approved by many countries due to its easy applicability and reproducibility. Its still debatable weather it has influenced post transplant survival. Objective: Evaluate the MELD score and risk factors associated to mortality in patients after LT. Material and methods: A retrospective analysis was carried on a prospectively maintained database on all transplants carried out between July 1999 and April 2012. Univariate and multivariate analysis were carried out to establish risk factors in the first month after liver transplantation. Cox regression and Kaplan Meier curves were used to establish long term results. Results: There were 57 transplants in 56 patients. One year graft and patient survival was 83 and 82% and 76 and 74% at 5 years. Hepatitis C virus and alcohol were the most common causes for transplantation with 52% of cases. Mean age was for donor and receptor was 29 and 52 years. Mean surgical time was 420 min and cold isquemia time never exceeded 8 h. When evaluating one month survival, significant variables on univariate analysis with a p value < 0.1 were MELD and CHILD scores, preoperative creatinine. RBC units used during surgery. These were included in the multivariate analysis and only the MELD score remained statistically significant [p = 0.011, RR (CI) of 1.196 (1.04-1.37)]. The COX regression also showed the impact of the MELD score on overall survival [p = 0.009, RR (CI) of 1.132 (1.034-1.240)]. The subgroup analysis with Kaplan-Meier curves showed a lower survival in relation to an increase in MELD score. (Log Rank 0.023 test) with a cutoff point of 17 and the majority of cases occurring during the first year. Conclusion: MELD score adversely impacts patient survival after LT and a system needs to be created to reduce waiting list mortality after LT without compromising post transplant results. The authors declares that there is no conflict of interest.

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2012-06-14   |   698 visitas   |   Evalua este artículo 0 valoraciones

Vol. 11 Núm.4. Julio-Agosto 2012 Pags. 577-582 Ann Hepatol 2012; 11(4)