MELD exceptions and new predictive score of death on long waiting lists for liver transplantation.
BACKGROUND
Cirrhosis related complications, considered MELD exceptions, proved to add prognostic value to the MELD score in predicting waiting list mortality.


OBJECTIVE
To identify the predictive value for death on a long waiting list (WL) for the complications of liver disease.


METHODS
During 2004-2007, 372 consecutive adult patients were listed for liver transplantation (LT). To identify the potential predictors of patient death, univariate and multivariate Cox's proportional hazards regression model was used.


RESULTS
In the univariate survival analysis the following variables were significant: spontaneous bacterial peritonitis, refractory ascites, hyponatremia, hepatic encephalopathy, hepatorenal syndrome, initial and current MELD score, initial and current Child-Pugh score. The independent predictors of death on our WL were: refractory ascites (p=0.002) and hepatorenal syndrome (p=0.002). Based on a logistic regression analysis a new score has been developed: Score = 1/(1+ exp(-(-4.38 + 1.34 x Refractory ascites + 0.9 x Hepatorenal syndrome + 0.15 x Current MELD). The c-statistic for the new score for prediction of death on the WL was 0.85 compared to 0.80 for current MELD score.


CONCLUSIONS
Refractory ascites and hepatorenal syndrome should add valuable points to the current MELD in order to better prioritize for LT patients included on long WL.


BACKGROUND
Liver transplantation (LT), Model for End-Stage Liver Disease (MELD), waiting list (WL), United Network for Organ Sharing (UNOS), standard deviation (SD), receiver operating characteristic (ROC), hepatitis B virus (HBV), hepatocellular carcinoma (HCC), positive predictive value (PPV), negative predictive value (NPV), Child-Turcotte-Pugh (CTP), hepatic venous pressure gradient (HVPG).
Iacob
S
S
Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. speranta.iacob@icfundeni.ro
Gheorghe
L
L
Iacob
R
R
Gheorghe
C
C
Hrehoreţ
D
D
Popescu
I
I
D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D018450:Disease Progression; D005260:Female; D005355:Fibrosis / Q000601:surgery; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014850:Waiting Lists