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Published on: August 14, 2017
Assessment of short-term survival after liver transplant by the Model for End-Stage Liver Disease
A L Buenadicha1, L G Martín, E E Martín
1Department of Digestive Surgery, Transplant Unit, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. alopezb.hrc@salud.madrid.org
Unlabelled:
The Model for End-Stage Liver Disease (MELD) score has demonstrated the ability to predict mortality among patients with chronic liver disease on the liver waiting list. The aim of this study was to assess the capability of the MELD score to correctly predict posttransplantation survival in Spain and to determine specific thresholds of MELD above which liver transplantation should be discouraged and the patient removed from the waiting list.
Methods:
In this study, we retrospectively applied the MELD score to 168 patients at time of transplantation to estimate 1-month and 3-month posttransplant survivals by stratifying them into four groups: group A, MELD score < 10; group B, MELD score 10-18; group C, MELD score 19-24; group D, MELD score > 24.
Results:
One-, 2-, and 3-month survivals were 84.3%, 80% and 79.5%, respectively. One-, 2-, and 3-month survivals in group A (18 patients) were identical (77.8%). In group B (80 patients), 1-month survival was 84.8%, and 2- and 3-month survivals were 78.4%. In group C (42 patients) 1-month survival was 90.5% and 2- and 3-month survivals were 88%. One-, 2-, and 3-month survivals in group D (28 patients) were 77.9%, 74%, and 70%, respectively. We defined a new group (group E) formed by patients with MELD score < or =24. When we compared 1-, 2-, and 3-month survival rates in group E (85.6%, 81.25%, and 81.25%, respectively) with survival rates in group D, the difference was not significant (P > .05).
Conclusions:
Although overall outcomes of patients whose MELD scores were high at the time of liver transplantation were inferior to those of patients whose MELD scores were lower, there was no significant difference for specific thresholds of MELD above which liver transplantation should be discouraged and the patient removed from the waiting list.
Insights
The Model for End-Stage Liver Disease (MELD) score predicts mortality in liver patients. This study found no specific MELD threshold to remove patients from the liver transplant waiting list, despite higher scores correlating with poorer outcomes.
Area of Science:
- Hepatology
- Transplantation Medicine
- Medical Statistics
Background:
- The Model for End-Stage Liver Disease (MELD) score is established for predicting mortality in patients with chronic liver disease awaiting liver transplantation.
- Accurate prediction of post-transplantation survival is crucial for optimizing liver allocation and patient management.
Purpose of the Study:
- To evaluate the MELD score's accuracy in predicting post-transplantation survival in Spain.
- To identify specific MELD score thresholds that might warrant discouraging liver transplantation and removing patients from the waiting list.
Main Methods:
- A retrospective analysis of 168 liver transplant recipients in Spain.
- Application of the MELD score at the time of transplantation.
- Stratification of patients into four groups based on MELD score (<10, 10-18, 19-24, >24) to assess 1-month and 3-month post-transplant survivals.
Main Results:
- Overall 1-, 2-, and 3-month survival rates were 84.3%, 80%, and 79.5%, respectively.
- Patients with MELD scores >24 (Group D) showed lower survival rates (77.9%, 74%, 70% at 1, 2, and 3 months).
- No statistically significant difference in survival was observed between patients with MELD scores <=24 and those with MELD scores >24.
Conclusions:
- While higher MELD scores at transplantation were associated with inferior outcomes, no specific MELD threshold was identified to definitively discourage transplantation.
- The study suggests that current MELD scoring may not provide a precise cutoff for removing patients from the liver waiting list based solely on predicted short-term survival.
