title: Survival benefit of liver transplantation and the effect of underlying liver disease.
abstract: BACKGROUND
  The benefit of liver transplantation relative to initial degree of underlying liver disease and time on the waiting list remains poorly defined. We sought to examine the survival benefit attributable to liver transplantation across a wide range of Model for End-Stage Liver Disease (MELD) scores.
  
  
  METHODS
  The study population included patients with end-stage liver disease enlisted in Rio Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted and transplanted patients were estimated using parametric and nonparametric methods. MELD score was utilized to account for underlying liver disease.
  
  
  RESULTS
  Of 1,130 eligible patients, 520 (46.0%) were transplanted, 266 (23.5%) died on the waiting list, 141 (12.5%) were excluded from the waiting list, and 203 (18.0%) remained enlisted and were awaiting transplantation at the time of last observation. At 1 year after transplantation, a MELD score of 15 represented a transition point in terms of overall survival benefit (MELD 10, 90% vs 83%; MELD 15, 81% vs 80%; MELD 20, 63% vs 78%; MELD 25, 42% vs 74%; MELD 30, 21% vs71%; enlisted vs transplant patients, respectively). MELD scores at which transplantation seemed to be beneficial relative to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2, and 5 years, respectively, from time of transplantation/enlistment.
  
  
  CONCLUSIONS
  Although patients with greater MELD scores enjoy a pronounced and early benefit from transplantation, patients with lesser MELD scores do gain from transplantation, although a greater period of time is needed to realize the survival benefit.
authors: Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors: Ana L
authors: AL
authors: Gleisner
authors: Alvaro
authors: A
authors: Muñoz
authors: Ajacio
authors: A
authors: Brandao
authors: Claudio
authors: C
authors: Marroni
authors: Maria Lucia
authors: ML
authors: Zanotelli
authors: Guido Gracco
authors: GG
authors: Cantisani
authors: Leila Beltrami
authors: LB
authors: Moreira
authors: Michael A
authors: MA
authors: Choti
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists