title: Model for end-stage liver disease-sodium and survival benefit in liver transplantation.
abstract: There are currently no studies calculating the survival benefit of liver transplantation (LT) according to model for end-stage liver disease-sodium (MELD-Na) and based on the competing risk (CR) method. We enrolled consecutive adult patients with chronic end-stage liver disease entering the waiting list (WL) for primary LT (WL group = 337) and undergoing LT (LT group = 220) in the period 2006-2009. Two independent multivariable regressions (WL and LT models) were created to measure the prognostic power of MELD-Na with respect to MELD. For the WL model, both Cox and CR multivariable analyses were performed. Estimates were finally included in a Markov model to calculate 3-year survival benefit. WL Cox model: MELD-Na (P < 0.0001) and MELD (P < 0.0001) significantly predicted survival. WL CR model: MELD-Na (P = 0.0045) and MELD (P = 0.0109) significantly predicted survival. LT Cox model: MELD-Na (P = 0.7608) and MELD score (P = 0.9413) had not correlation with survival. Benefit model: MELD and MELD-Na had an overlapping significant impact on 3-year survival benefit; CR method determined a significant decrease in 3-year life expectancy (LE) estimations. MELD-Na and MELD scores similarly predicted 3-year LT survival benefit, but the gain in LE is significantly lower when a CR method is adopted.
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico Azienda, Università di Padova, Padova, Italy. alessandro.vitale@unipd.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bertacco
authors.forename: Martina
authors.initials: M
authors.lastname: Gambato
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.forename: Rafael Ramirez
authors.initials: RR
authors.lastname: Morales
authors.forename: Anna C
authors.initials: AC
authors.lastname: Frigo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
mesh_terms: D058625:End Stage Liver Disease / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D012964:Sodium