title: High model for end-stage liver disease score as a predictor of survival during long-term follow-up after liver transplantation.
abstract: BACKGROUND
  The allocation of cadaveric livers for transplantation in the United States is now based on the severity of illness as determined by the Model for End-Stage Liver Disease (MELD), which was developed to predict short-term mortality in patients with cirrhosis. However, its impact to predict posttransplantation survival is controversial. The objective of this study was to determine the association of various pretransplantation risk factors, including the MELD score and whether its use to allocate organs is likely to lead to overall poorer outcomes of liver transplantation.
  
  
  METHODS
  The 1,032 consecutive adult liver transplantation patients at King's College Hospital between 2 January 1994 and 29 December 2001 were examined for 9 preoperative risk factors, including MELD score, using univariate and multivariate techniques. Based on their pretransplantation MELD scores, we categorized recipients as low (<15) medium (15-25), or high (>25). Kaplan-Meier patient survival analysis was used to identify differences in outcomes.
  
  
  RESULTS
  The patients had a mean age of 47.2 years and mean posttransplantation follow-up of 5.3 years. Univariate analysis showed recipient diabetes mellitus, renal dysfunction, and pretransplantation MELD score to be associated with patient survival. Multivariate analysis showed the MELD score to be significantly associated with death during long-term follow-up.
  
  
  CONCLUSIONS
  A high pretransplantation MELD score was associated with poor posttransplantation outcomes.
authors.affiliation: Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Gunma University, Showamachi, Japan. hidesu@med.gunma-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Suzuki
authors.forename: A S R
authors.initials: AS
authors.lastname: Bartlett
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
authors.forename: W
authors.initials: W
authors.lastname: Jassem
authors.forename: M
authors.initials: M
authors.lastname: Rela
authors.forename: N
authors.initials: N
authors.lastname: Heaton
mesh_terms: D000328:Adult; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome