RESUMO
In patients undergoing orthotopic liver transplantation [OLT], some studies have shown that a higher preopcrative 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 inlraoperativc risks [Xia et al 2008]. 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. After approval iron- ethical committee and a written consent from every patient a prospective observational study including 40 patients scheduled for living donor liver transplantation in Wady El nile hospital. Patients classified according to MELD score into group 1 [Gl] with score <25 and group2 [G2] > 25. Haemodynamic, metabolic and electrolytes data collected during the three phases: pro anhepatic, anhepatic and post reperfusion phase and follow up for 1[st] post operative week then two years mortality. G2 associated with significant intraoperative haemodynamic disturbances in all stages compared to Gl 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 GL 2 years mortality in Gl 5 cases [25%] while 10 cases [50%] in G2,, time of ICU stay was 5.1 days in G1 and 7 days in G2 time of hospital stay was 21.6 days in Gl and 26.2 days in G2 High MELD score patients associated with more intraoperative haemodynamic, metabolic and electrolyte disturbances, longer postoperative ICU and hospital stay and higher mortality