title: A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation.
abstract: The Model for End-Stage Liver Disease (MELD) score is now the criteria for allocation in liver transplantation for patients with chronic disease. Although the score has been effective in the prediction of mortality in patients awaiting liver transplantation, its abilities to predict posttransplantation outcome need study. The aim of this study is to compare outcome in the first 2 years after liver transplantation according to the pretransplantation MELD score. The study includes 669 consecutive patients who underwent primary liver transplantation between December 1993 and October 1999 in a single transplant center. Patients who died of malignancy were excluded from the series. Pretransplantation MELD score was calculated using the United Network for Organ Sharing formula. Patients were stratified according to MELD score less than 15, 15 to 24, and 25 and higher. Posttransplantation survival at 3, 6, 12, 18, and 24 months was significantly lower in the groups with a higher MELD score. The difference was significant for hepatitis C and noncholestatic liver diseases, but not cholestatic diseases. In patients with a MELD score between 15 and 24, survival was significantly greater with cholestatic diseases and lower in patients with hepatitis C. In our study, pretransplantation MELD score correlates with survival in the first 2 years after transplantation. There is a survival advantage for patients with cholestatic diseases compared with those with hepatitis C. These findings suggest the need to readjust MELD score-based allocation decisions to consider patient outcome.
authors.affiliation: Transplantation Services, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Onaca
authors.forename: Marlon F
authors.initials: MF
authors.lastname: Levy
authors.forename: Edmund Q
authors.initials: EQ
authors.lastname: Sanchez
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Fasola
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Thomas
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weinstein
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Murray
authors.forename: Robert M
authors.initials: RM
authors.lastname: Goldstein
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors