MELD and other predictors of survival after liver transplantation

• Published in: Clinical transplantation Vol. 23; no. 2; pp. 220 - 227
• Main Authors: Brandão, Ajacio, Fuchs, Sandra C., Gleisner, Ana L., Marroni, C., Zanotelli, Maria L., Cantisani, Guido
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.03.2009; Wiley
• Subjects: Adolescent; Adult; Age Factors; Aged; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Child; Child, Preschool; Cohort Studies; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Graft Rejection; Graft Survival; Humans; Liver Failure - mortality; Liver Failure - surgery; Liver Neoplasms - mortality; Liver Neoplasms - surgery; liver transplant; Liver Transplantation - mortality; Liver Transplantation - statistics & numerical data; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; model for end-stage liver disease; Other diseases. Semiology; outcome; Prognosis; Risk Factors; ROC Curve; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; survival rates; Tissue, organ and graft immunology; Young Adult; stage liver disease; Prognosis; Liver; survival rates; Hepatic disease; Homotransplantation; Liver failure; Surgery; Evolution; Graft; liver transplant; outcome; Digestive system; Rate; Prediction; Survival; model for end; Medicine; Clinical stage; Treatment; Digestive diseases; End; Models; Predictive factor; Liver transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2008.00943.x

:  Background:  This study examined how reliable is the pre‐transplant model for end‐stage liver disease (MELD) score in predicting post‐transplantation survival and analyzed variables associated with patient survival. Methods:  A cohort study was conducted. Receiver operating characteristic curve c‐statistics were used to determine the ability of MELD score to predict mortality. The Kaplan–Meier (KM) method was used to analyze survival as a function of time regarding the MELD score and Child‐Turcotte‐Pugh (CTP) category. The Cox model was employed to assess the association between baseline risk factors and mortality. Results:  Recipients and donors were mostly male, with a mean age of 51.6 and 38.5 yr, respectively (n = 436 transplants). The c‐statistic values for three‐month patient mortality were 0.60 and 0.61 for MELD score and CTP category, respectively. KM survival at three, six and 12 months were lower in those who had a MELD score ≥21 or were CTP category C. Multivariate analysis revealed that recipient age ≥65 yr, MELD ≥ 21, CTP C category, bilirubin ≥ 7 mg/dL, creatinine ≥ 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non‐white color donor skin were predictors of mortality. Conclusions:  Severe pre‐transplant liver disease, age ≥ 65, non‐white skin donor, and hepatocellular carcinoma are associated with poor outcome.