Waiting Time, not Donor-Risk-Index, Is a Major Determinant for Beneficial Outcome after Liver Transplantation in High-MELD Patients

Abstract

Introduction: Due to the increasing donor shortage in Western Europe, patients undergo liver transplantation actually only with high MELD-scores. Furthermore, the waiting times are more and more prolonged. In this study, we analyze high-MELD patients who underwent liver transplantation at our center. Methods: Since the implementation of the MELD-score within the Eurotransplant region (December 2006), 45 patients with a lab-MELD-score ≥ 36 underwent liver transplantation at our center. We correlated the 6-months-survival with donor data (especially the donor risk index), the waiting time from reaching a lab-MELD-score ≥ 36 up to the liver transplantation and the recipient's state prior transplantation. Results: The 6-months-survival in our cohort is 68,8 %. The waiting time of the survivors was significantly shorter compared to the patients who died within the first six months after the liver transplantation (median survivors: 2 ± 1,88 days; median dead: 4 ± 2,42 days; p = 0,049). The donor risk index showed no significant differences between both groups (median survivors: 1,72 ± 0,4; median dead: 1,89 ± 0,33; p = not significant). Furthermore, the recipient's state prior transplantation (dialysis, mechanical ventilation, catecholamine administration) showed no significant association with the outcome. In a multivariate analysis, the waiting time was also the only independent risk factor associated with a inferior outcome. Conclusion: The outcome after liver transplantation in high-MELD patients is worse compared to the long-term survival of transplanted patients with a marked lower MELD-score. Especially the time interval between reaching a lab-MELD score ≥36 to the liver transplantation is a major determinant for survival. Since the donor risk index is not associated with a worsened outcome, transplantation centers should accept even marginal organs for high-MELD patients to keep the waiting time as short as possible.