Luc Massicotte1, François Martin Carrier2, Pierre Karakiewicz3, Zoltan Hevesi4, Lynda Thibeault5, Anna Nozza6, Marc Bilodeau7, André Roy8, André Y Denault9. 1. Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. Electronic address: luc.massicotte@umontreal.ca. 2. Department of Anesthesiology and Department of Medicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. 3. Department of Surgery, Urology Division, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. 4. Department of Anesthesiology, University of Wisconsin, Madison, WI, Wisconsin. 5. Department of Social and Preventive Medicine, Public Health School, Université de Montréal, Montréal, Quebec, Canada. 6. Montreal Health Innovation Coordinating Center, Montréal, Quebec, Canada. 7. Department of Medicine, Liver Unit, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. 8. Department of Surgery, Hepato-Biliary Division, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. 9. Department of Anesthesiology and Department of Medicine, Critical Care Division, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; Department of Anesthesiology, Institut de Cardiologie de Montréal, Montréal, Quebec, Canada.
Abstract
OBJECTIVE: The goal of this study was to evaluate the effect of the Model for End-Stage Liver Disease (MELD)-based allocation system on mortality, bleeding, and transfusion requirement in orthotopic liver transplantation (OLT). DESIGN: OLTs were studied for this observational study (before-and-after observational cohort study). SETTING: One community hospital. PARTICIPANTS: The study comprised 686 patients who underwent 750 consecutive OLTs. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patients who underwent OLT in the MELD era had an adjusted lower 1-year mortality (adjusted odds ratio 0.45 [0.24-0.83]) compared with patients who underwent OLT the pre-MELD era. No significant difference in 1-month mortality was observed. Other variables with a significant effect on 1-year mortality in multivariate analysis were preoperative international normalized ratio, intraoperative use of a phlebotomy, total intraoperative volume of crystalloid infused, and retransplantation. Blood loss was greater in the MELD era (median difference 200 mL; p < 0.001), as were red blood cell, fresh frozen plasma, and cryoprecipitate transfusions. More patients in the MELD era received at least 1 transfusion (27% v 20%; p = 0.024). CONCLUSION: The MELD allocation system did not affect 1-month mortality, but a decrease in 1-year mortality was demonstrated. Blood loss and transfusions increased during OLTs performed in the MELD era. The role of other variables should be explored further to explain postoperative morbidity and mortality.
OBJECTIVE: The goal of this study was to evaluate the effect of the Model for End-Stage Liver Disease (MELD)-based allocation system on mortality, bleeding, and transfusion requirement in orthotopic liver transplantation (OLT). DESIGN: OLTs were studied for this observational study (before-and-after observational cohort study). SETTING: One community hospital. PARTICIPANTS: The study comprised 686 patients who underwent 750 consecutive OLTs. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS:Patients who underwent OLT in the MELD era had an adjusted lower 1-year mortality (adjusted odds ratio 0.45 [0.24-0.83]) compared with patients who underwent OLT the pre-MELD era. No significant difference in 1-month mortality was observed. Other variables with a significant effect on 1-year mortality in multivariate analysis were preoperative international normalized ratio, intraoperative use of a phlebotomy, total intraoperative volume of crystalloid infused, and retransplantation. Blood loss was greater in the MELD era (median difference 200 mL; p < 0.001), as were red blood cell, fresh frozen plasma, and cryoprecipitate transfusions. More patients in the MELD era received at least 1 transfusion (27% v 20%; p = 0.024). CONCLUSION: The MELD allocation system did not affect 1-month mortality, but a decrease in 1-year mortality was demonstrated. Blood loss and transfusions increased during OLTs performed in the MELD era. The role of other variables should be explored further to explain postoperative morbidity and mortality.
Authors: Luc Massicotte; Zoltan Hevesi; Cédrick Zaouter; Lynda Thibeault; Pierre Karakiewicz; Louise Roy; André Roy Journal: Transplant Direct Date: 2022-03-25