title: Model for end-stage liver disease and model for end-stage liver disease-Na scores predict both before-listing and wait-list mortality.
abstract: BACKGROUND
  Due to the organ shortage, many patients die without transplantation, even before completing an evaluation for candidacy. We analyzed outcomes after patient referral and factors associated with mortality both before and after listing for cadaveric donor liver transplantation.
  
  
  METHODS
  We analyzed 132 consecutive patients who were evaluated for candidacy for cadaveric donor liver transplantation between 2003 and 2010.
  
  
  RESULTS
  The study included 69 men and 63 women of median age 49 years (range, 1-65). Etiologies of diseases were acute hepatic failure (n=19), liver cirrhosis due to hepatitis B or C (n=36), primary biliary cirrhosis (n=19), nonviral cirrhosis (n=14), hepatocellular carcinoma (n=13), or other causes (n=31). After evaluation for candidacy, we listed 68 (52%), subjects whereas 24 (18%) died before listing. Factors affecting death before listing were the levels of albumin (P<.001), bilirubin (P<.001), sodium (P<.001), international normalized ratio (INR; P<.001), Model for End-stage Liver Disease (MELD) score (P<.001), MELD-Na score (P<.001), and Child-Pugh-Turcotte (CPT) score (P<.001). Based on multivariate Cox regression analysis, MELD score (hazard ratio [HR] 1.201, P=.017), MELD-Na score (HR 1.244, P=.014), CPT score (HR 1.468, P=.033), and INR (HR 0.491, P=.027) were independently associated with death before listing. Among 68 listed candidates, 11 (16%) underwent transplantation, whereas 29 (43%) died without transplantation. Based on multivariate Cox regression analysis, MELD score (HR 1.102, P=.001), MELD-Na score (HR 1.128, P=.001), and CPT score (HR 1.282, P=.038) independently predicted wait-list mortality. All 11 patients who underwent cadaveric liver transplantation were alive at 29 months (range, 1-55) after transplantation.
  
  
  CONCLUSIONS
  Patients with a higher MELD, higher MELD-Na, and higher CPT score at referral were at greater risk for death without transplantation, especially before listing. Evaluation for transplantation candidacy is a time-consuming process. Therefore, earlier referral is mandatory to achieve successful listing for transplantation.
authors.affiliation: Department of Gastroenterology, University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yamashiki
authors.forename: Y
authors.initials: Y
authors.lastname: Sugawara
authors.forename: S
authors.initials: S
authors.lastname: Tamura
authors.forename: J
authors.initials: J
authors.lastname: Kaneko
authors.forename: K
authors.initials: K
authors.lastname: Nojiri
authors.forename: T
authors.initials: T
authors.lastname: Aoki
authors.forename: Y
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: K
authors.initials: K
authors.lastname: Hasegawa
authors.forename: K
authors.initials: K
authors.lastname: Koike
authors.forename: N
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012964:Sodium