Pretransplant MELD score and post liver transplantation survival in the UK and Ireland
It has been shown that the model for end‐stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without transplantation. Four recent studies carried out in the United States have demonstrated that the MELD score obtained immediately prior to transplantat...
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Published in | Liver transplantation Vol. 10; no. 7; pp. 903 - 907 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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Hoboken
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01.07.2004
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Abstract | It has been shown that the model for end‐stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without transplantation. Four recent studies carried out in the United States have demonstrated that the MELD score obtained immediately prior to transplantation is also associated with post‐transplant patient survival. Our aim was to evaluate how accurately the MELD score predicts 90‐day post‐transplant survival in adult patients with chronic liver disease in the UK and Ireland. The UK and Ireland Liver Transplant Audit has data on all liver transplants since 1994. We studied survival of 3838 adult patients after first elective liver transplantation according to United Network for Organ Sharing categories of their MELD scores (≤ 10, 11–18, 19–24, 25–35, ≥36). The overall survival at 90‐days was 90.2%. The 90‐day survival varied according to the United Network for Organ Sharing MELD categories (92.6%, 91.9%, 89.7%, 89.7%, and 70.8%, respectively; P < 0.01). Therefore, only those patients with a MELD score of 36 or higher (3% of the patients) had a survival that was markedly lower than the rest. As a consequence, the ability of the MELD score to discriminate between patients who were dead or alive was poor (c‐statistic 0.58). Re‐estimating the coefficients in the MELD regression model, even allowing for nonlinear relationships, did not improve its discriminatory ability. In conclusion, in the UK and Ireland the MELD score is significantly associated with post‐transplant survival, but its predictive ability is poor. These results are in agreement with results found in the United States. Therefore, the most appropriate system to support patient selection for transplantation will be one that combines a pretransplant survival model (e.g., MELD score) with a properly developed post‐transplant survival model. (Liver Transpl 2004;10:903–907.) |
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AbstractList | It has been shown that the model for end-stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without transplantation. Four recent studies carried out in the United States have demonstrated that the MELD score obtained immediately prior to transplantation is also associated with post-transplant patient survival. Our aim was to evaluate how accurately the MELD score predicts 90-day post-transplant survival in adult patients with chronic liver disease in the UK and Ireland. The UK and Ireland Liver Transplant Audit has data on all liver transplants since 1994. We studied survival of 3838 adult patients after first elective liver transplantation according to United Network for Organ Sharing categories of their MELD scores (< or = 10, 11-18, 19-24, 25-35, > or =36). The overall survival at 90-days was 90.2%. The 90-day survival varied according to the United Network for Organ Sharing MELD categories (92.6%, 91.9%, 89.7%, 89.7%, and 70.8%, respectively; P < 0.01). Therefore, only those patients with a MELD score of 36 or higher (3% of the patients) had a survival that was markedly lower than the rest. As a consequence, the ability of the MELD score to discriminate between patients who were dead or alive was poor (c-statistic 0.58). Re-estimating the coefficients in the MELD regression model, even allowing for nonlinear relationships, did not improve its discriminatory ability. In conclusion, in the UK and Ireland the MELD score is significantly associated with post-transplant survival, but its predictive ability is poor. These results are in agreement with results found in the United States. Therefore, the most appropriate system to support patient selection for transplantation will be one that combines a pretransplant survival model (e.g., MELD score) with a properly developed post-transplant survival model. It has been shown that the model for end‐stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without transplantation. Four recent studies carried out in the United States have demonstrated that the MELD score obtained immediately prior to transplantation is also associated with post‐transplant patient survival. Our aim was to evaluate how accurately the MELD score predicts 90‐day post‐transplant survival in adult patients with chronic liver disease in the UK and Ireland. The UK and Ireland Liver Transplant Audit has data on all liver transplants since 1994. We studied survival of 3838 adult patients after first elective liver transplantation according to United Network for Organ Sharing categories of their MELD scores (≤ 10, 11–18, 19–24, 25–35, ≥36). The overall survival at 90‐days was 90.2%. The 90‐day survival varied according to the United Network for Organ Sharing MELD categories (92.6%, 91.9%, 89.7%, 89.7%, and 70.8%, respectively; P < 0.01). Therefore, only those patients with a MELD score of 36 or higher (3% of the patients) had a survival that was markedly lower than the rest. As a consequence, the ability of the MELD score to discriminate between patients who were dead or alive was poor (c‐statistic 0.58). Re‐estimating the coefficients in the MELD regression model, even allowing for nonlinear relationships, did not improve its discriminatory ability. In conclusion, in the UK and Ireland the MELD score is significantly associated with post‐transplant survival, but its predictive ability is poor. These results are in agreement with results found in the United States. Therefore, the most appropriate system to support patient selection for transplantation will be one that combines a pretransplant survival model (e.g., MELD score) with a properly developed post‐transplant survival model. (Liver Transpl 2004;10:903–907.) It has been shown that the model for end-stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without transplantation. Four recent studies carried out in the United States have demonstrated that the MELD score obtained immediately prior to transplantation is also associated with post-transplant patient survival. Our aim was to evaluate how accurately the MELD score predicts 90-day post-transplant survival in adult patients with chronic liver disease in the UK and Ireland. The UK and Ireland Liver Transplant Audit has data on all liver transplants since 1994. We studied survival of 3838 adult patients after first elective liver transplantation according to United Network for Organ Sharing categories of their MELD scores (< or = 10, 11-18, 19-24, 25-35, > or =36). The overall survival at 90-days was 90.2%. The 90-day survival varied according to the United Network for Organ Sharing MELD categories (92.6%, 91.9%, 89.7%, 89.7%, and 70.8%, respectively; P < 0.01). Therefore, only those patients with a MELD score of 36 or higher (3% of the patients) had a survival that was markedly lower than the rest. As a consequence, the ability of the MELD score to discriminate between patients who were dead or alive was poor (c-statistic 0.58). Re-estimating the coefficients in the MELD regression model, even allowing for nonlinear relationships, did not improve its discriminatory ability. In conclusion, in the UK and Ireland the MELD score is significantly associated with post-transplant survival, but its predictive ability is poor. These results are in agreement with results found in the United States. Therefore, the most appropriate system to support patient selection for transplantation will be one that combines a pretransplant survival model (e.g., MELD score) with a properly developed post-transplant survival model. |
Author | van der Meulen, Jan H. P. Rela, Mohamed Lewsey, James D. Jacob, Mathew Gimson, Alex Toogood, Giles J. Copley, Lynn P. |
Author_xml | – sequence: 1 givenname: Mathew surname: Jacob fullname: Jacob, Mathew email: mjacob@rcseng.ac.uk – sequence: 2 givenname: Lynn P. surname: Copley fullname: Copley, Lynn P. – sequence: 3 givenname: James D. surname: Lewsey fullname: Lewsey, James D. – sequence: 4 givenname: Alex surname: Gimson fullname: Gimson, Alex – sequence: 5 givenname: Giles J. surname: Toogood fullname: Toogood, Giles J. – sequence: 6 givenname: Mohamed surname: Rela fullname: Rela, Mohamed – sequence: 7 givenname: Jan H. P. surname: van der Meulen fullname: van der Meulen, Jan H. P. |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/15237375$$D View this record in MEDLINE/PubMed |
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Copyright | Copyright © 2004 American Association for the Study of Liver Diseases |
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Can outcome be predicted? publication-title: Transplantation. – volume: 53 start-page: 457 year: 1958 ident: 10.1002/lt.20169-BIB11 publication-title: J Am Statistical Assoc doi: 10.1080/01621459.1958.10501452 contributor: fullname: Kaplan – volume: 57 start-page: 1028 year: 1994 ident: 10.1002/lt.20169-BIB19 publication-title: Transplantation. doi: 10.1097/00007890-199404150-00008 contributor: fullname: Doyle – volume: 7 start-page: 173 year: 2001 ident: 10.1002/lt.20169-BIB17 publication-title: Liver Transpl doi: 10.1053/jlts.2001.22180 contributor: fullname: Freeman – volume: 33 start-page: 464 year: 2001 ident: 10.1002/lt.20169-BIB1 publication-title: Hepatology doi: 10.1053/jhep.2001.22172 contributor: fullname: Kamath – volume: 356 start-page: 621 year: 2000 ident: 10.1002/lt.20169-BIB20 publication-title: Lancet doi: 10.1016/S0140-6736(00)02603-9 contributor: fullname: Adam – volume-title: Statistical Software: Release 7.0. year: 2001 ident: 10.1002/lt.20169-BIB15 contributor: fullname: Statacorp – volume: 9 start-page: 527 year: 2003 ident: 10.1002/lt.20169-BIB22 publication-title: Liver Transpl doi: 10.1053/jlts.2003.50089 contributor: fullname: Thuluvath – volume: 8 start-page: 851 year: 2002 ident: 10.1002/lt.20169-BIB18 publication-title: Liver Transpl doi: 10.1053/jlts.2002.35927 contributor: fullname: Freeman – volume: 3 start-page: 626 year: 2003 ident: 10.1002/lt.20169-BIB7 publication-title: Am J Transpl doi: 10.1034/j.1600-6143.2003.00092.x contributor: fullname: Onaca – year: 2003 ident: 10.1002/lt.20169-BIB10 – volume: 9 start-page: 117 year: 2003 ident: 10.1002/lt.20169-BIB4 publication-title: Liver Transpl doi: 10.1053/jlts.2003.50027 contributor: fullname: Onaca – volume: 236 start-page: 315 year: 2002 ident: 10.1002/lt.20169-BIB21 publication-title: Ann Surg doi: 10.1097/00000658-200209000-00008 contributor: fullname: Ghobrial – start-page: 49 volume-title: Texts in Statistical Science year: 1994 ident: 10.1002/lt.20169-BIB13 contributor: fullname: Collett – volume: 143 start-page: 29 year: 1982 ident: 10.1002/lt.20169-BIB12 publication-title: Radiology doi: 10.1148/radiology.143.1.7063747 contributor: fullname: Hanley – volume: 71 start-page: 284 year: 2001 ident: 10.1002/lt.20169-BIB6 publication-title: Transplantation doi: 10.1097/00007890-200101270-00011 contributor: fullname: Kim – volume: 8 start-page: 795 year: 2002 ident: 10.1002/lt.20169-BIB16 publication-title: Liver Transpl doi: 10.1053/jlts.2002.34637 contributor: fullname: Llado – year: 2003 ident: 10.1002/lt.20169-BIB9 contributor: fullname: UK Transplant – volume: 77 start-page: 99 year: 2004 ident: 10.1002/lt.20169-BIB3 publication-title: Transplantation doi: 10.1097/01.TP.0000101009.91516.FC contributor: fullname: Desai – volume: 9 start-page: 124 year: 2003 ident: 10.1002/lt.20169-BIB24 publication-title: Liver Transpl doi: 10.1053/jlts.2003.50030 contributor: fullname: Kim – volume: 48 start-page: 444 year: 1989 ident: 10.1002/lt.20169-BIB8 publication-title: Transplantation doi: 10.1097/00007890-198909000-00019 contributor: fullname: Neuberger – volume: 31 start-page: 864 year: 2000 ident: 10.1002/lt.20169-BIB2 publication-title: Hepatology doi: 10.1053/he.2000.5852 contributor: fullname: Malinchoc – volume: 9 start-page: 473 year: 2003 ident: 10.1002/lt.20169-BIB5 publication-title: Liver Transpl; doi: 10.1053/jlts.2003.50090 contributor: fullname: Saab – volume: 74 start-page: 187 year: 1972 ident: 10.1002/lt.20169-BIB14 publication-title: J Royal Statistical Soc contributor: fullname: Cox – volume: 17 start-page: 401 year: 2003 ident: 10.1002/lt.20169-BIB23 publication-title: Clin Transpl doi: 10.1034/j.1399-0012.2003.00068.x contributor: fullname: Bilbao |
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Snippet | It has been shown that the model for end‐stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without... It has been shown that the model for end-stage liver disease (MELD) score is an accurate predictor of survival in patients with liver disease without... |
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SubjectTerms | Adult Female Humans Ireland Liver Failure - classification Liver Failure - surgery Liver Transplantation - mortality Liver Transplantation - statistics & numerical data Male Middle Aged Predictive Value of Tests Severity of Illness Index Time Factors Tissue and Organ Procurement - statistics & numerical data Treatment Outcome United Kingdom |
Title | Pretransplant MELD score and post liver transplantation survival in the UK and Ireland |
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