Prognostic factors for short and long-term survival in patients selected for liver transplantation

Indices for predicting of survival are essential tools for assessing prognosis and establishing priority for liver transplantation. Our aim was to investigate the survival and prognostic significance of Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) scale for short and long-term survival prognosis in waitlist of patients selected for liver transplantation.

The group of 236 patients with diagnosis of different chronic liver disease was investigated in period of 4.5 years. Persons with CTP scoring > or =10 were included into the waitlist for liver transplantation. Other inclusion criteria were based on CTP scoring > or =7 plus one or more liver cirrhosis complications. The cumulative and mean survivals were evaluated according to the Kaplan-Meier statistical analysis. The distribution and the survival data for the patients were based on biochemical variables. The clinical status of waitlist patients was evaluated by applying the CTP and MELD scales. The short and long-term survival prognosis was assessed. The odds ratios with 95% confidence interval univariate analysis were evaluated.

During the period of 4.5 years 45 persons were selected for waitlist group. Mortality rate was 51.1%, average survival--17.9 months. The significant trends towards higher cumulative proportion of survival were observed for the patients with low serum bilirubin, creatinine and low blood urea. The highest mortality rate was in the group with CTP scores > or =12. The highest mortality and the shortest average of survival were in the group of cases with the highest scores. It was established the significant difference for short-term survival (less than 3 months) prognosis in MELD scale. CTP scores had no predictive influence for survival during 3 months. Also both scoring had high prognostic value for prediction of the long-term survival (more than 3 months). Deterioration of cumulative survival and overall survival were affected by increase of serum bilirubin, blood urea and creatinine. Increase of scores in CTP and MELD scale had the direct positive correlation with increased mortality. MELD scale has higher capability to predict short-term mortality risk in patients with end-stage liver disease. CTP and MELD scales have proven good prognostic capabilities both for short and long-term survival in patients with chronic liver disease.