Is meld score a reliable outcome predictor in living donor liver transplantation ?

الملخص EN

Background: In patients undergoing orthotopic liver transplantation (OLT), some studies have shown that a higher preoperative MELD score is associated with higher morbidity and mortality (Saab et al., 2003).

Other studies also suggest that higher MELD scores are associated with increased intraopera ve risks (Xia et al., 2008).

Objectives: to evaluate the impact of preoperative MELD status on metabolic, electrolyte and haemodynamic changes during living donar liver transplantation, and consequently on outcome and for right choice of candidate who will get greatest benefit from transplantation.

Methods: After approval from ethical committee and a written consent from every pa ent a prospec ve observa onal study including 40 pa ents scheduled for living donor liver transplanta on in Wady El nile hospital.

Pa ents classified according to MELD score into group1 (G1) with score <25 and group2 (G2) > 25.

Haemodynamic, metabolic and electrolytes data collected during the three phases: pre anhepa c, anhepa c and post reperfusion phase and follow up for 1st post operative week then two years mortality.

Results: G2 associated with significant intraopera ve haemodynamic disturbances in all stages compared to G1 in the form of lower mean arterial blood pressure, lower systemic vascular resistance, higher pulmonary vascular resistance, and higher cardiac output.

Also there were more intraoperative metabolic and electrolyte disturbances as there were more acidosis, lower standard bicarbonate values, more base deficits, more negative anion gap and strong ion difference, higher serum potassium level, poor intraoperative glycemic control and much higher blood lactate level.

Also there were higher early mortality in G2 8 cases (40%) while 3 cases (15%) in G1, 2 years mortality in G1 5 cases (25%) while 10 cases (50%) in G2,, me of ICU stay was 5.1 days in G1 and 7 days in G2 me of hospital stay was 21.6 days in G1 and 26.2 days in G2.

Conclusion: High MELD score patients associated with more intraoperative haemodynamic, metabolic and electrolyte disturbances, longer postoperative ICU and hospital stay and higher mortality.-