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SINGLE CENTER EXPERIENCE IN LIVER TRANSPLANT FOR HIGH MELD RECIPIENTS

SINGLE CENTER EXPERIENCE IN LIVER TRANSPLANT FOR HIGH MELD RECIPIENTS.

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SINGLE CENTER EXPERIENCE IN LIVER TRANSPLANT FOR HIGH MELD RECIPIENTS

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  1. SINGLE CENTER EXPERIENCE IN LIVER TRANSPLANT FOR HIGH MELD RECIPIENTS Background : MELD score is the criteria to allocate grafts in Brazil. Donors are critical issue with just 7.0 donors per million people.Patients are frequently very sick becoming high risk recipients. Increasing experience of a single center can improve results.Aim: Analyze results of a single center in recipients with MELD score ≥ 30, in the last 3 years.Casuistic and Methods: Single center data collected prospectively of 33 liver transplant recipients with MELD score ≥ 30 transplanted from May 2005 to September 2008.Results: Donor's characteristics (medians): age 42 years (range 18 – 76), 54.6% with 1 vasopressor, 42.4% with >1 vasopressors, BMI was 25 kg/m2, sodium 153 mEq/L (range 133 – 189), ALT 42.0 U/L, AST 44.0 U/L, 63.6% had a cardiac arrest and 42.4% had a controlled infection. Causes of death: 42.5% had a cranioencephalic trauma, 48.5% hemorrhagic cerebral vascular accident and 9% other causes.Graft's characteristics: 33.3% had grade I liver steatosis, 51.5% grade II and 15.2% had grade III. Arterial anomalies were present in 26.7%. Median cold ischemia time: 490.5 minutes and median warm ischemia time was 59.5 minutes. Recipient's characteristics (medians): age was 56 years, MELD score: 33%, 39.4% HCV, 30.3% Laennec's cirrhosis, 21.2% auto-immune liver disease and 15.2% cryptogenic cirrhosis. Median intra-operatory blood transfusion was 3, median intensive care stay was 3 days, median length of hospital stay was 20.5 days. Three patients with mild, one with moderate and one with severe acute rejection. Two patients had vascular complications: one with hepatic artery thrombosis (retransplanted) and other with hepatic artery stenosis (endovascular stent). Graft survival rate was 76.5% in the first year. Patients survival were 84.2% in 3 months, 74.6% in one year and 69.3% in two years.Conclusion: Liver transplant can have acceptable results in high meld recipients. Ben-Hur Ferraz-Neto, Andre I. David, Maria Paula V.Coelho, Sergio P. Meira Filho, Marcio D. De Almeida, Bianca Della-Guardia, Marcelo B. Rezende, Rogerio C. Afonso Liver Transplant Program, Hospital Israelita Albert Einstein, São Paulo, Brazil • References • Washburn WK, Pollock BH, Nichols L, et al: Impact of recipient MELD score on resource utilization. Am J Transplant, 6:2449, 2006. • http://www.ustransplant.org • http://www.abto.org.br

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