High Model for End-Stage Liver Disease Score as a Predictor of Survival During Long-Term Follow-up After Liver Transplantation

doi:10.1016/j.transproceed.2011.11.013

Transplantation Proceedings

Volume 44, Issue 2, March 2012, Pages 384-388

https://doi.org/10.1016/j.transproceed.2011.11.013 Get rights and content

Abstract

Background

The allocation of cadaveric livers for transplantation in the United States is now based on the severity of illness as determined by the Model for End-Stage Liver Disease (MELD), which was developed to predict short-term mortality in patients with cirrhosis. However, its impact to predict posttransplantation survival is controversial. The objective of this study was to determine the association of various pretransplantation risk factors, including the MELD score and whether its use to allocate organs is likely to lead to overall poorer outcomes of liver transplantation.

Methods

The 1,032 consecutive adult liver transplantation patients at King's College Hospital between 2 January 1994 and 29 December 2001 were examined for 9 preoperative risk factors, including MELD score, using univariate and multivariate techniques. Based on their pretransplantation MELD scores, we categorized recipients as low (<15) medium (15–25), or high (>25). Kaplan-Meier patient survival analysis was used to identify differences in outcomes.

Results

The patients had a mean age of 47.2 years and mean posttransplantation follow-up of 5.3 years. Univariate analysis showed recipient diabetes mellitus, renal dysfunction, and pretransplantation MELD score to be associated with patient survival. Multivariate analysis showed the MELD score to be significantly associated with death during long-term follow-up.

Conclusions

A high pretransplantation MELD score was associated with poor posttransplantation outcomes.

Section snippets

Patients and Methods

All adult (>16 years) patients who underwent LT at King's College Hospital between 1 January 1994 and 31 December 2001 were identified by retrospective review of our database, excluding patients who underwent retransplantation or LT for acute liver failure. Variables thought to be important to predict long-term survival after LT were identified; donor and recipient ages, cold ischemia time, recipient sex, and body mass index (BMI, kg/m²), presence of diabetes mellitus (DM), pretransplantation

Results

The patient demographics are shown in Table 1 The recipient mean age was 47.2 years, and mean donor age 42.2 years. The pretransplantation CP score was A (21.2%), B (29.4%), or C (49.4%). The immediate pretransplantation MELD scores were <15 (45.1%), 15–25 (26.7%), or >25 (28.2%). The mean operative time was 388.5 minutes. The mean cold ischemia time was 11.7 hours; no cold ischemia time was >20 hours. Inferior vena cava preservation was performed from 1996. Therefore, cross-clamping with a

Discussion

In our single transplant center experience, a cutoff value of 25 in the MELD score had a significant influence on 1-year survival after LT. The difference was maintained throughout the 10 years after transplantation. Graft survival was also significantly lower among patients with the highest MELD scores.

The MELD is based on 3 biochemical variables, one of which is the serum creatinine level. Preoperative serum creatinine levels have been shown to be an important predictor of short-term graft

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Cited by (15)

A good prognostic predictor for liver transplantation recipients with benign end-stage liver cirrhosis
2017, Hepatobiliary and Pancreatic Diseases International
Post-transplant model for predicting mortality (PMPM, calculated as −5.359+1.988xln (serum creatinine [mg/dL])+1.089xln (total bilirubin [mg/dL])) score has been proved to be a simple and accurate model for predicting the prognosis after liver transplantation (LT) in a single center study. Here we aim to verify this model in a large cohort of patients.
A total of 2727 patients undergoing LT with end-stage liver cirrhosis from January 2003 to December 2010 were included in this retrospective study. Data were collected from the China Liver Transplant Registry (CLTR). PMPM score was calculated at 24-h and 7-d following LT. According to the PMPM score at 24-h, all patients were divided into the low-risk group (PMPM score <-1.4, n=2509) and the high-risk group (PMPM score ≤-1.4, n=218). The area under receiver operator characteristic curve (AUROC) was calculated for evaluating the prognostic accuracy.
The 1-, 3-, and 5-year patient survival rates in the low-risk group were significantly higher than those in the high-risk group (90.23%, 88.01%, and 86.03% vs 63.16%, 59.62%, and 56.43%, respectively, P<0.001). In the high-risk group, 131 patients had a decreased PMPM score (≤-1.4) at 7-d, and their cumulative survival rate was significantly higher than the other 87 patients with sustained high PMPM score (≥-1.4) (P<0.001). For predicting 3-month mortality, PMPM score showed a much higher AUROC than post-transplant MELD score (P<0.05).
PMPM score is a simple and effective tool to predict short-term mortality after liver transplantation in patients with benign liver diseases, and an indicator for prompt salvaging treatment as well.
Living donor liver transplant versus cadaveric liver transplant survival in relation to model for end-stage liver disease score
2015, Transplantation Proceedings
The Model for End-Stage Liver Disease (MELD) score is universally used to prioritize patients on the liver transplant waiting list. It is potentially used to predict survival as well. There has been conflicting evidence on the use of living donor liver transplantation (LDLT) in patients with high MELD scores. We reported retrospective data comparing survival between LDLT and deceased donor liver transplantation (DDLT) In relation to MELD score in a single-center experience.
We retrospectively reviewed our records from 2001 to 2013 for LDLT and DDLT. Data reviewed include the numbers of patients for LDLT and DDLT, age, sex, MELD score, etiology of liver disease, hepatocellular carcinoma, re-transplantation, median follow-up, mortality (with 1 month, 1 year, or after 1 year), and cause of death. Only adults are included in this analysis. Patients were categorized into MELD scores above and below 25. Kaplan-Meier analysis was used for survival, and the log-rank χ² test was used for comparison, with a value of P < .05 used for significance.
The total number of transplanted patients at King Faisal Specialist Hospital, Riyadh, Saudi Arabia, was 491. There were 222 patients for LDLT and 269 patients for DDLT. The median age was 53 years (15–80 years), and 292 were male (59.5%). The overall 1-, 3-, and 5-year Kaplan-Meier survival rates of LDLT and DDLT were 89%, 85%, and 84%, respectively, for MELD score below 25, and 80%,78%, and 77%, respectively, for MELD score greater than or equal to 25.
Our data showed no difference between the survival rates of the two groups (DDLT versus LDLDT), nor that high MELD score has a negative impact on survival. A larger cohort of patients may be needed to confirm these findings.
Mind the model for end-stage liver disease: Model for end-stage liver disease score as an indicator of hemoderivate transfusion and survival in liver transplantation
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Citation Excerpt :
These results may lead us to question liver transplantation in patients with MELD score ≥36. This point is reflected in other articles with different values ranging from 25 to 40 [15,16], including some of them where a relationship between high MELD score and liver transplant outcomes is not demonstrated [16]. According to our data, MELD score should be a good parameter to identify those patients with a high demand for hemoderivate transfusion, and MELD score also has a direct relationship with patient survival.
The scarcity of liver donors has increased the necessity to closely select recipients to improve liver transplantation outcomes. If we were able to recognize those recipients with the best outcomes, then this could result in a better and more accurate selection of our donors. Hemoderivate transfusion is one of the main important factors to analyse. We reviewed the data of all of our liver transplant recipients from May 1998 to December 2013 and selected 888 patients with complete records. We divided these patients into 5 groups to get a better selection. We found differences between these groups with respect to the following: recipient age at the time of transplantation, percentage of patients with hepatocarcinoma, and those with hepatitis C virus (HCV)-related etiology. Also, intensive care unit (ICU) time and the need for retransplantation were distinctive factors with observable differences between our groups. With respect to model for end-stage liver disease (MELD) score, the groups were clearly defined by their mean MELD score, finding significant statistical differences between these groups with respect to this score. We also found a significant relationship between MELD scores and survival in the different groups. This is also the first review in which the MELD score and intraoperative transfusion requirements are well associated with patient and graft survival.
Factors affecting the regeneration of liver graft after living related liver transplantation: A preliminary study
2013, Transplantation Proceedings
Citation Excerpt :
Previous authors have reported that pre-transplant encephalopathy, higher modified MELD scores >31 (including points for persistent ascites and low serum sodium), and greater donor age (>50 y) were independent factors predicting graft failure upon multivariate analysis.3 A higher MELD score (≧30) correlates with a poor outcome after liver transplantation.4,6,7 High risk patients with the deteriorated conditions preoperatively and high MELD scores, larger graft volumes are necessary to address the excessive metabolic and synthetic demands that may lead to graft dysfunction or failure.
Development of a Novel Prognostic Nomogram for High Model for End-Stage Liver Disease Score Recipients Following Deceased Donor Liver Transplantation
2022, Frontiers in Medicine
Development and Validation of a Model to Predict Long-Term Survival After Liver Transplantation
2021, Liver Transplantation

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Advances in liver transplantationRecipient candidate: Evaluation using model for end stage liver diseaseHigh Model for End-Stage Liver Disease Score as a Predictor of Survival During Long-Term Follow-up After Liver Transplantation

Abstract

Background

Methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

Hepatology

Liver Transplant

Liver Transplant

Hepatology

Hepatology

Liver Transpl

Am J Transplant

Lancet

Lancet

A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts

Hepatology

The elderly liver transplant recipient: a call for caution

Ann Surg

Advances in liver transplantation
Recipient candidate: Evaluation using model for end stage liver disease
High Model for End-Stage Liver Disease Score as a Predictor of Survival During Long-Term Follow-up After Liver Transplantation