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MELD and other predictors of survival after liver transplantation
Author(s) -
Brandão Ajacio,
Fuchs Sandra C.,
Gleisner Ana L.,
Marroni C.,
Zanotelli Maria L.,
Cantisani Guido
Publication year - 2009
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2008.00943.x
Subject(s) - medicine , liver transplantation , transplantation , surgery , intensive care medicine
Background: This study examined how reliable is the pre‐transplant model for end‐stage liver disease (MELD) score in predicting post‐transplantation survival and analyzed variables associated with patient survival. Methods: A cohort study was conducted. Receiver operating characteristic curve c ‐statistics were used to determine the ability of MELD score to predict mortality. The Kaplan–Meier (KM) method was used to analyze survival as a function of time regarding the MELD score and Child‐Turcotte‐Pugh (CTP) category. The Cox model was employed to assess the association between baseline risk factors and mortality. Results: Recipients and donors were mostly male, with a mean age of 51.6 and 38.5 yr, respectively (n = 436 transplants). The c ‐statistic values for three‐month patient mortality were 0.60 and 0.61 for MELD score and CTP category, respectively. KM survival at three, six and 12 months were lower in those who had a MELD score ≥21 or were CTP category C. Multivariate analysis revealed that recipient age ≥65 yr, MELD ≥ 21, CTP C category, bilirubin ≥ 7 mg/dL, creatinine ≥ 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non‐white color donor skin were predictors of mortality. Conclusions: Severe pre‐transplant liver disease, age ≥ 65, non‐white skin donor, and hepatocellular carcinoma are associated with poor outcome.