[The application of MELD score in patients submitted to liver transplantation: a retrospective analysis of survival and the predictive factors in the short and long term].
BACKGROUND
The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. There are few reports studying the correlation between MELD and long-term posttransplantation survival.


OBJECTIVE
To assess the value of pretransplant MELD in the prediction of posttransplant survival.


METHODS
The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base. We excluded acute liver failure, retransplantation and reduced or split-livers. The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk. The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction). The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival. For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables. ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh.


RESULTS
A total of 232 patients with 10 years follow up were available. The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 11.5. For MELD score > or =20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium. For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium. The regression univariated analyses came up with the following risk factors for death: score MELD > or = 25, blood requirements, recipient creatinine clearance pretransplant and age donor > or =50. After stepwise analyses, only red cell requirement was predictive. Patients with MELD score < 25 had a 68.86%, 50,44% and 41,50% chance for 1, 5 and 10-year survival and > or =25 were 39.13%, 29.81% and 22.36% respectively. Patients without hyponatremia were 65.16%, 50.28% and 41,98% and with hyponatremia 44.44%, 34.28% and 28.57% respectively. Patients with IDR > or =1.7 showed 53.7%, 27.71% and 13.85% and index donor risk <1.7 was 63.62%, 51.4% and 44.08%, respectively. Age donor > 50 years showed 38.4%, 26.21% and 13.1% and age donor < or =50 years showed 65.58%, 26.21% and 13.1%. Association with delta-MELD score did not show any significant difference. Expanded criteria donors were associated with primary non-function and severe liver dysfunction. Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium.


CONCLUSIONS
In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival.
Boin
Ilka de Fátima Santana Ferreira
Ide F
Unidade de Transplante de Fígado do Hospital de Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas. ilkaboin@gmail.com
Leonardi
Marília Iracema
MI
Udo
Elisabete Yoko
EY
Sevá-Pereira
Tiago
T
Stucchi
Raquel Silveira Bello
RS
Leonardi
Luiz Sergio
LS
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000401:mortality; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors
D003404:Creatinine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin