A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation

Onaca, Nicholas; Levy, Marlon F.; Sanchez, Edmund Q.; Chinnakotla, Srinath; Fasola, Carlos G.; Thomas, Mark J.; Weinstein, Jeffrey; Murray, Natalie; Goldstein, Robert M.; Klintmalm, Göran B.

doi:10.1053/jlts.2003.50027

Cited by 185 publications

(146 citation statements)

References 12 publications

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“…Recently published data indicate that improved posttransplantation survival in HCV-infected patients is directly correlated with lower pretransplantation MELD scores. 24 In our study, the overall MELD score in patients who underwent LDLT, particularly in LDLT patients with HCC, was significantly lower than in CAD patients, and it could be postulated that outcomes in these patients would be improved when compared with CAD patients. When comparing LDLT patients without HCC (mean MELD score, 11) to patients with HCC (mean MELD score, 15.6) and CAD patients (mean MELD score, 28), there was no difference related to percentage of patients with HCV recurrence, time to recurrence, and graft and patient survival.…”

Section: Discussionmentioning

confidence: 48%

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Gaglio

Malireddy

Levitt

et al. 2003

Liver Transplantation

125

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Histologic injury caused by recurrent hepatitis C virus (HCV) has been reported in up to 90% of HCV-infected patients who undergo liver transplantation with a cadaveric graft. However, the natural history of HCV after living donor liver transplantation (LDLT) is not well described. We performed a retrospective analysis of 68 consecutive HCV-infected adult patients: 45 recipients of cadaveric grafts (CAD) were compared with 23 LDLT patients. Elevated serum transaminases, positive HCV RNA, and liver biopsy consistent with histologic evidence of HCV defined recurrence. When comparing CAD with LDLT, both the incidence of HCV recurrence and time to recurrence were not different. The overall incidence of severe sequelae of HCV recurrence, either cholestatic hepatitis, grade III-IV inflammation, and/or HCV-induced graft failure requiring retransplantation, was also not different when comparing CAD with LDLT. However, when comparing CAD versus LDLT, no CAD patient developed cholestatic hepatitis C, compared with 17% of LDLT who developed this complication (P ‫؍‬ .001). Thus, in this patient population, the timing and incidence of HCV recurrence were not different when comparing CAD versus LDLT, but the incidence of cholestatic hepatitis was significantly greater in patients with HCV who underwent LDLT. (Liver Transpl 2003;9:1028-1035.) E nd stage liver disease caused by hepatitis C virus (HCV) is the most common indication for liver transplantation in the United States. However, complications caused by recurrent HCV infection are increasingly being recognized; in patients with active HCV replication before transplantation, reacquisition of viremia after transplantation is universal, and allograft hepatitis caused by HCV occurs in up to 90% of patients followed for 5 years. 1-9 Although histologic injury in the allograft caused by HCV is exceedingly common, disease progression after the development of hepatitis is variable, with some patients experiencing indolent disease and others rapidly progressing to cirrhosis and liver failure. In patents who develop HCV-associated cirrhosis posttransplantation, rapid decompensation is a common occurrence. It has been reported that up to 42% of patients with HCV-associated cirrhosis posttransplantation develop decompensation manifested as ascites, encephalopathy, or hepatic hydrothorax, and fewer than 50% of patients survive more than 1 year after the development of decompensation. 10-12 Thus, both prospective and retrospective data are emerging that indicate that the progression of HCV after orthotopic liver transplantation is accelerated when compared with nontransplantation patients. This has been attributed to multiple factors, including the impact of immunosuppression on viral replication and host defenses. 13 Several lines of anecdotal evidence suggest that HCV recurrence might be more severe in recipients of living donor liver transplantation (LDLT). We hypothesize that postoperative liver regeneration in the partial graft procured from living donors may facilitate HCV repli...

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Section: Discussionmentioning

confidence: 48%

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Gaglio

Malireddy

Levitt

et al. 2003

Liver Transplantation

125

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“…10 However, a retrospective study of 669 patients found higher MELD score correlated well with decreased 1-and 2-year survival when patients were stratified into three groups (MELD score Ͻ15, 15 to 24, and Ͼ24). 11 Differences in survival between groups were statistically significant for patients with hepatitis C and noncholestatic liver disease only. There are no data correlating MELD scores with outcomes in the living donor liver transplant recipient population, and evolving data from cadaveric transplantation studies may not be applicable to LDLT.…”

Section: Discussionmentioning

confidence: 95%

Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients

Hayashi

Forman

Steinberg

et al. 2003

Liver Transplantation

102

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A dult-to-adult right hepatic lobe living donor liver transplantation (LDLT) has grown rapidly in the setting of a cadaveric organ shortage. 1 Initial outcomes have been promising for both recipients and donors. 2,3 Nevertheless, this treatment must be approached with careful forethought. Criteria for both recipient and donor selection are just evolving. United Network of Organ Sharing (UNOS) status 2A proved to be an important recipient exclusionary criterion because such patients have threefold greater mortality compared with recipients of cadaveric livers. 4 In February 2002, the national organ allocation policy for liver transplantation changed. As a result, the priority for liver transplantation is currently based on the Model for End-Stage Liver Disease (MELD) score, which is a whole-number score derived from objective laboratory values. Unfortunately, there are no data regarding outcomes for living donor liver transplant recipients based on MELD score. Based on the poor outcomes in status 2A transplant recipients, we were concerned that high MELD scores would be associated with poor outcomes after LDLT. Therefore, we retrospectively analyzed the short-term outcomes (post-LDLT hospitalization days, 1-year patient and graft survival) in 62 living donor liver transplant recipients relative to MELD scores. Because the MELD score is designed to predict short-term mortality, we believed a high preoperative MELD score may predict greater postoperative morbidity and mortality. Methods PatientsWe retrospectively analyzed all adult living donor liver transplant recipients at the University of Colorado Health Sciences Center in Denver between August 1997 and March 2002. We excluded patients with fulminant hepatic failure. MELD ScoresThe most recent pretransplantation internationalized normalized ratio and bilirubin and creatinine levels were used to calculate a MELD score for each patient. Scores were calcuFrom the *Divisions

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“…Based on easily measurable laboratory data 2,5,6 , the MELD score has been considered more transparent and objective 2,5,7 for the ordination of liver disease on the waiting list for TH. Nevertheless, although it has been validated as a predictor of mortality in the list, the role of this scoring system for predicting survival after HT remains controversial 3,6,8 , which could suggest the need to readjust the graft allocation criteria for a model that also took into consideration the results of TH 8 . The objective of this study was to evaluate the accuracy of preoperative MELD score to predict survival after TH and also analyze factors predictive of mediumterm survival (24 months).…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

Batista¹,

Sabat²,

Melo³

et al. 2012

Rev. Col. Bras. Cir.

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. 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 Results ResultsResults 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. Conclusion Conclusion Conclusion Conclusion Conclusion: 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.

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A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation

Cited by 185 publications

References 12 publications

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors

Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients

Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

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