Six score systems to evaluate candidates with advanced cirrhosis for orthotopic liver transplant: Which is the winner?
Many prognostic systems have been devised to predict the outcome of liver transplantation (LT) candidates. Today, the Model for End-Stage Liver Disease (MELD) is widely used for organ allocation, but it has shown some limitations. The aim of this study was to investigate the performance of MELD compared to 5 different score models. We evaluated the prognostic ability of MELD, modified Child-Turcotte-Pugh, MELD-sodium, United Kingdom MELD, updated MELD, and integrated MELD in 487 candidates with cirrhosis for LT at the Bologna Transplant Centre, Bologna, Italy, between 2003 and 2008. Calibration analysis by Hosmer-Lemeshow test, calibration curves, and concordance c-statistics (area under the receiver operating characteristic curve [AUC]) were calculated at 3, 6, and 12 months. Actual cumulative survival curves, taking into account the event of interest in the presence of competing risk, were obtained using the best cutoffs identified by AUC. For each score, the Hosmer-Lemeshow test revealed a good calibration. Integrated MELD showed calibration curves closer to the line of perfect predicting ability, followed by MELD-sodium at 3 months and modified Child-Turcotte-Pugh at 6 months. MELD-sodium AUCs at 3 and 6 months (0.798 and 0.765, respectively) and integrated MELD AUC at 6 months (0.792) were better than standard MELD (P < 0.05). Actual survival curves showed that these 2 scores were able to identify the patients with the highest drop-out risk. In conclusion, MELD-sodium and integrated MELD were the best prognostic models to predict drop-out rates among patients awaiting LT.
Biselli
Maurizio
M
Department of Clinical Medicine, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
Gitto
Stefano
S
Gramenzi
Annagiulia
A
Di Donato
Roberto
R
Brodosi
Lucia
L
Ravaioli
Matteo
M
Grazi
Gian Luca
GL
Pinna
Antonio Daniele
AD
Andreone
Pietro
P
Bernardi
Mauro
M
D000328:Adult; D019540:Area Under Curve; D002138:Calibration; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors