MELD and other predictors of survival after liver transplantation.
BACKGROUND
This study examined how reliable is the pre-transplant model for end-stage liver disease (MELD) score in predicting post-transplantation survival and analyzed variables associated with patient survival.


METHODS
A cohort study was conducted. Receiver operating characteristic curve c-statistics were used to determine the ability of MELD score to predict mortality. The Kaplan-Meier (KM) method was used to analyze survival as a function of time regarding the MELD score and Child-Turcotte-Pugh (CTP) category. The Cox model was employed to assess the association between baseline risk factors and mortality.


RESULTS
Recipients and donors were mostly male, with a mean age of 51.6 and 38.5 yr, respectively (n = 436 transplants). The c-statistic values for three-month patient mortality were 0.60 and 0.61 for MELD score and CTP category, respectively. KM survival at three, six and 12 months were lower in those who had a MELD score > or =21 or were CTP category C. Multivariate analysis revealed that recipient age > or =65 yr, MELD > or = 21, CTP C category, bilirubin > or = 7 mg/dL, creatinine > or = 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non-white color donor skin were predictors of mortality.


CONCLUSIONS
Severe pre-transplant liver disease, age > or = 65, non-white skin donor, and hepatocellular carcinoma are associated with poor outcome.
Brandão
Ajacio
A
Liver Transplantation Group, Complexo Hospitalar Santa Casa, Porto Alegre-RS, Brazil. ajaccio@via-rs.net
Fuchs
Sandra C
SC
Gleisner
Ana L
AL
Marroni
C
C
Zanotelli
Maria L
ML
Cantisani
Guido
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult