The Model for End-Stage Liver Disease (MELD) score is now the criteria for allocation in liver transplantation for patients with chronic disease. Although the score has been effective in the prediction of mortality in patients awaiting liver transplantation, its abilities to predict posttransplantation outcome need study. The aim of this study is to compare outcome in the first 2 years after liver transplantation according to the pretransplantation MELD score. The study includes 669 consecutive patients who underwent primary liver transplantation between December 1993 and October 1999 in a single transplant center. Patients who died of malignancy were excluded from the series. Pretransplantation MELD score was calculated using the United Network for Organ Sharing formula. Patients were stratified according to MELD score less than 15, 15 to 24, and 25 and higher. Posttransplantation survival at 3, 6, 12, 18, and 24 months was significantly lower in the groups with a higher MELD score. The difference was significant for hepatitis C and noncholestatic liver diseases, but not cholestatic diseases. In patients with a MELD score between 15 and 24, survival was significantly greater with cholestatic diseases and lower in patients with hepatitis C. In our study, pretransplantation MELD score correlates with survival in the first 2 years after transplantation. There is a survival advantage for patients with cholestatic diseases compared with those with hepatitis C. These findings suggest the need to readjust MELD scorebased allocation decisions to consider patient outcome. (Liver Transpl 2003;9:117-123.)

Patients with RPBC demonstrated prolonged survival. Clinical factors did not aid in predicting RPBC. The clinical course of RPBC appears to be different than in the earlier years of liver transplantation. Immunosuppression may play a role. The use and type of antimetabolite drugs had no affect on recurrence. RPBC demonstrated a different clinical course with tacrolimus treatment (shorter time to recurrence) and increased incidence when compared with cyclosporine treatment. Controlled randomized studies are necessary to determine differences between tacrolimus and cyclosporine treatment, if any.

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We prospectively collected data on 1,429 liver transplant recipients between December 1984 and December 1998. A utoimmune hepatitis (AIH) is a recognized pathological process first described in the 1950s. However, diagnostic criteria have been clearly defined only recently. 1 AIH affects predominantly middle-aged women and often responds to immunosuppressive therapy. When it leads to chronic liver failure, it constitutes an indication for orthotopic liver transplantation (OLT). 1 Because of post-OLT immunosuppressive therapy, recurrence in liver allografts has been believed to be relatively low. 2,3 This has been supported by reports from both American and European centers 4 dating back to the mid-1980s. Although these studies made use of histological and biochemical parameters for their diagnosis of recurrence, precise patterns of histopathologic findings were not described. In addition, hepatitis C virus infection was not completely excluded because a marker of viremia was not yet available. 5 In this study, we reviewed our experience using OLT for the treatment of AIH. We analyzed the incidence of recurrence and possible risk factors associated with recurrence. We also studied the impact of AIH recurrence on patient and graft survival, HLA typing, episodes of rejection, liver function test (LFT) results, and other biochemical and histological parameters. Materials and MethodsData were collected prospectively between December 1984 and December 1998 on a total of 1,429 patients who underwent OLT at Baylor University Medical Center (Dallas, TX). There were 753 men and 676 women. Mean age at OLT was 48 Ϯ 12 (SD) years. The initial diagnosis of AIH was based on: (1) detection of antinuclear antibodies, anti-smooth muscle antibodies, or antiliver/kidney microsomal type 1 antibodies in titers greater than 1:80; (2) total gamma globulin or immunoglobulin G (IgG) levels greater than 1.5 times the upper limit of normal; (3) absence of IgM antibodies to hepatitis A virus; (4) absence of hepatitis B virus surface antigen and antibodies to hepatitis B virus core antigen; (5) absence of antibodies to hepatitis C virus and hepatitis C virus RNA by polymerase chain reaction assay; (6) laboratory findings of abnormal LFT results (alanine aminotransferase [ALT] or aspartate aminotransferase [AST]); (7) absence of liver disease attributable to alcohol or hepatotoxic drugs; and (8) presence of histological findings consistent with interface hepatitis or piecemeal necrosis, concurrent lobular hepatitis, and no biliary lesions or other changes.Biochemical and clinical data were collected preoperatively and at various times after OLT. All transplant recipients