Factors that predict survival in patients with cirrhosis considered for liver transplantation.
OBJECTIVE
To identify prognostic factors for survival at 6 and 12 months in patients evaluated for liver transplantation using Child-Pugh (CP) classification and the Model for End-Stage Liver Disease (MELD) score.


METHODS
We evaluated 144 patients with cirrhosis who were candidates for liver transplantation. We excluded patients with hepatocellular carcinoma, recent liver recipients, and patients who died because of factors unrelated to liver disease. The studied variables were age and sex; prothrombin time; platelet count; albumin, cholesterol, bilirubin, creatinine, and serum sodium concentrations; CP classification and MELD score; and the presence of ascites, encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and previous variceal bleeding. Data were processed using statistical software (SPSS version 13.0).


RESULTS
Of the 144 patients, 27 (18.7%) did not survive because of complications of liver disease. Univariate analysis showed the most significant factors to be sex, prothrombin time, bilirubin and albumin levels; ascites, encephalopathy, CP classification, and MELD score. At Cox regression analysis, only CP classification proved to be a valid predictor of survival in our cohort. The lowest survival according to CP classification at 6 and 12 months corresponded to stage C and to MELD scores higher than 15.


CONCLUSIONS
Child-Pugh classification is an independent prognostic factor for recipient survival. Stage C in the CP classification and a MELD score higher than 15 were strongly related to worse survival. Both scores must be taken into consideration for adequate evaluation of liver transplantation for candidates.
Samada Suarez
M
M
Centro de Investigaciones Médico Quirúrgicas, Havana, Cuba. marcia.samada@infomed.sld.cu
Hernández Perera
J C
JC
Ramos Robaina
L
L
Barroso Márquez
L
L
González Rapado
L
L
Cepero Valdés
M
M
Hernández Rivero
H
H
Abdo Cuza
A
A
Valdés
A Roque
AR
Pérez Bernal
J
J
Bernardos
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery*; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D011517:Prothrombin Time; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult