title: The MELD score predicts the short-term and overall survival after liver transplantation in patients with primary sclerosing cholangitis or autoimmune liver diseases.
abstract: OBJECTIVE
  Liver transplantation (LT) is well established in patients with autoimmune liver disease. Despite excellent outcomes, organ scarcity demands careful patients' selection and timing of transplantation.
  
  
  METHODS
  This retrospective study analyzes data of 79 consecutive patients with primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and overlap syndrome, undergoing LT between 2001 and 2012. Overall survival (OS) and graft survival were assessed using Kaplan-Meier estimate. Multivariate survival analysis was performed to identify prognostic factors by using Cox regression model.
  
  
  RESULTS
  After 59.6-month median follow-up, the 5-year OS and graft survival were 75.3 and 68.8%, respectively. The 5-year survival rates for patients with PSC (n=57), AIH (n=17), and overlap syndrome (n=5) were 76.3, 76.0, and 60.0%. The 90-day mortality rate of 70.0% was significantly higher in patients with a labMELD score≥20 (n=10) compared to 26.1% in 69 patients with a labMELD<20 (p=0.009). A lab Model for End-Stage Liver Disease (MELD) score≥20 was an independent predictor of impaired OS (p=0.050, hazard ratio 2.5). The 5-year OS was 55.7% in patients with a labMELD score≥20 compared to 84.7% in patients with a labMELD score<20.
  
  
  CONCLUSIONS
  The recipients' MELD score is a predictor for the short-term outcome after LT in patients with autoimmune liver disease. Meticulous selection for transplant listing remains necessary to safe scarce donor organs.
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Hoffmann
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Norbert
authors.initials: N
authors.lastname: Hillebrand
authors.forename: Tom
authors.initials: T
authors.lastname: Ganten
authors.forename: Daniel
authors.initials: D
authors.lastname: Gotthardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Longerich
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000401:mortality / Q000601:surgery*; D001706:Biopsy; D015209:Cholangitis, Sclerosing / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate
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