title: Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients.
abstract: The Model for End-Stage Liver Disease (MELD) has been proposed as a replacement for the Child-Turcotte-Pugh (CTP) classification to stratify patients for prioritization for orthotopic liver transplantation (OLT). Improved classification of patients with decompensated cirrhosis might allow timely OLT before the development of life-threatening complications, reducing the number of critically ill patients listed as United Network for Organ Sharing (UNOS) status 2A at the time of OLT. We compared the ability of the MELD and CTP scores to predict pre-OLT disease severity, as well as outcome and resource utilization post-OLT. Data from 42 consecutive UNOS status 2A patients undergoing OLT at a single center were used to calculate MELD and CTP scores at the time of status 2A listing. Multivariate analysis was used to determine the relationship between these scores and pre-OLT disease severity measures, survival post-OLT, and measures of resource use post-OLT. The MELD was superior to CTP score in predicting pre-OLT requirements for mechanical ventilation and dialysis. Neither score correlated with the resource utilization parameters studied. Only two patients died within 3 months post-OLT; neither score was predictive of survival in this cohort. In summary, the MELD is superior to CTP score in estimating pre-OLT disease severity in UNOS status 2A patients and thus may help risk stratify status 2A or decompensated status 2B OLT candidates and optimize the timing of OLT. However, neither score correlated with resource use post-OLT in the strata of critically ill patients.
authors.affiliation: Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA. rb464@columbia.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.forename: K Shiva
authors.initials: KS
authors.lastname: Kumar
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
authors.forename: Milan
authors.initials: M
authors.lastname: Kinkhabwala
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Rudow
authors.forename: Patricia
authors.initials: P
authors.lastname: Harren
authors.forename: Steven
authors.initials: S
authors.lastname: Lobritto
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005544:Forecasting; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008107:Liver Diseases / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome