• Luc Massicotte, François Martin Carrier, Pierre Karakiewicz, Zoltan Hevesi, Lynda Thibeault, Anna Nozza, Marc Bilodeau, André Roy, and André Y Denault.
• Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada. Electronic address: luc.massicotte@umontreal.ca.
• J. Cardiothorac. Vasc. Anesth. 2019 Oct 1; 33 (10): 2719-2725.

ObjectiveThe 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).DesignOLTs were studied for this observational study (before-and-after observational cohort study).SettingOne community hospital.ParticipantsThe study comprised 686 patients who underwent 750 consecutive OLTs.InterventionNone.Measurements And Main ResultsPatients 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).ConclusionThe 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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