Assessment of short-term survival after liver transplant by the Model for End-Stage Liver Disease.
The Model for End-Stage Liver Disease (MELD) score has demonstrated the ability to predict mortality among patients with chronic liver disease on the liver waiting list. The aim of this study was to assess the capability of the MELD score to correctly predict posttransplantation survival in Spain and to determine specific thresholds of MELD above which liver transplantation should be discouraged and the patient removed from the waiting list.


METHODS
In this study, we retrospectively applied the MELD score to 168 patients at time of transplantation to estimate 1-month and 3-month posttransplant survivals by stratifying them into four groups: group A, MELD score < 10; group B, MELD score 10-18; group C, MELD score 19-24; group D, MELD score > 24.


RESULTS
One-, 2-, and 3-month survivals were 84.3%, 80% and 79.5%, respectively. One-, 2-, and 3-month survivals in group A (18 patients) were identical (77.8%). In group B (80 patients), 1-month survival was 84.8%, and 2- and 3-month survivals were 78.4%. In group C (42 patients) 1-month survival was 90.5% and 2- and 3-month survivals were 88%. One-, 2-, and 3-month survivals in group D (28 patients) were 77.9%, 74%, and 70%, respectively. We defined a new group (group E) formed by patients with MELD score < or =24. When we compared 1-, 2-, and 3-month survival rates in group E (85.6%, 81.25%, and 81.25%, respectively) with survival rates in group D, the difference was not significant (P > .05).


CONCLUSIONS
Although overall outcomes of patients whose MELD scores were high at the time of liver transplantation were inferior to those of patients whose MELD scores were lower, there was no significant difference for specific thresholds of MELD above which liver transplantation should be discouraged and the patient removed from the waiting list.
Buenadicha
A L
AL
Department of Digestive Surgery, Transplant Unit, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. alopezb.hrc@salud.madrid.org
Martín
L G
LG
Martín
E E
EE
Pajares
A dP
Ad
Pérez
A M
AM
Seral
C C
CC
Marugán
R B
RB
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis; D013997:Time Factors