Employment of MELD score for the prediction of survival after liver transplantation.
OBJECTIVE
To assess the overall accuracy of the preoperative MELD score for predicting survival after liver transplantation (LT) and appraise medium-term (24 months) predictors of survival.


METHODS
We conducted a cross-sectional study including patients transplanted by the Department of General Surgery and Liver Transplantation of the Oswaldo Cruz University Hospital, University of Pernambuco, between July 15th, 2003 and July 14th, 2009. We used analysis of area under ROC (receiver operating characteristic) as a summary measure of the performance of the MELD score and assessed predictors of medium-term survival using univariate and multivariate analysis.


RESULTS
The cumulative survival of three, six, 12 and 24 months of the 208 patients studied was 85.1%, 79.3%, 74.5% and 71.1%, respectively. The preoperative MELD score showed a low discriminatory power for predicting survival after TH. By univariate analysis, we identified intraoperative transfusion of red blood cells (p <0.001) and platelets (p = 0.004) and type of venous hepatocaval anastomosis (p = 0.008) as significantly related to medium-term survival of the patients studied. However, by multivariate analysis only red blood cell transfusion was a significant independent predictor of outcome.


CONCLUSIONS
The MELD score showed low overall accuracy for predicting post-transplant survival of patients studied, among which only intraoperative transfusion of red blood cells was identified as an independent predictor of survival in the medium term after TH.
Department of General Surgery and Liver Transplantation of the Oswaldo Cruz University Hospital, University of Pernambuco, Recife, Pernambuco, Brazil. t.paulo@bol.com.br
Thales Paulo
TP
Batista
Bernardo David
BD
Sabat
Paulo Sérgio Vieira de
PS
Melo
Luiz Eduardo Correia
LE
Miranda
Olival Cirilo Lucena da
OC
Fonseca-Neto
Américo Gusmão
AG
Amorim
Cláudio Moura
CM
Lacerda
D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D015996:Survival Rate; D013997:Time Factors