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MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation.
Transpl Int. 2005 Jan; 18(1):65-72.TI

Abstract

The Model for End-stage Liver Disease (MELD) provides a score able to predict short-term mortality in patients awaiting liver transplantation (LT). In the early 2002, United Network for Organ Sharing (UNOS) has proposed to replace the conventional statuses 3, 2B, and 2A with a modified MELD score. However, the accuracy of the MELD model to predict post-transplantation outcome is fairly elusive. In the present study we investigated the predictive value of the MELD score for short-term patient and graft mortality in comparison with conventional UNOS status. Sixty-nine patients listed at UNOS status 3 (n = 5), 2B (n = 55) or 2A (n = 9) who underwent LT were enrolled according to strict criteria. No donor-related parameters affected 3-month patient survival. Through univariate Cox regression, pretransplantation international normalized ratio (P = 0.049) and activated partial thromboplastin time (P = 0.032) were significantly associated with 3-month patient survival, although not in the subsequent multivariate analysis. The overall MELD score was 17 +/- 6.63 (median: 16, range: 4-34), increasing from UNOS Status 3 to 2A (r(2) = 0.171, P = 0.0001). No significant difference occurred in the median MELD score between patients who underwent a second LT and those who did not (P =0.458). The inter-rate agreement between UNOS status and MELD score after categorization for clinical urgency showed a fair agreement (kappa = 0.244). The 3-month patient and graft mortality was 15.94% and 20.29% respectively. The concordance statistic did not find significance between UNOS status and MELD score for 3-month patient (P = 0.283) or graft mortality (P = 0.957), although the MELD score revealed a major sensitivity for short-term patient mortality (0.637; 95%CI: 0.513-0.75). These findings suggest the need to implement MELD model accuracy for both inter-rate agreement with UNOS Status and patient outcome.

Authors+Show Affiliations

Department of Transplantation, S. Martino University Hospital, Largo R. Benzi 10, 16132 Genoa, Italy. gsantori@medscape.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15612986

Citation

Santori, Gregorio, et al. "MELD Score Versus Conventional UNOS Status in Predicting Short-term Mortality After Liver Transplantation." Transplant International : Official Journal of the European Society for Organ Transplantation, vol. 18, no. 1, 2005, pp. 65-72.
Santori G, Andorno E, Morelli N, et al. MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation. Transpl Int. 2005;18(1):65-72.
Santori, G., Andorno, E., Morelli, N., Antonucci, A., Bottino, G., Mondello, R., Castiglione, A. G., Valente, R., Ravazzoni, F., Di Domenico, S., & Valente, U. (2005). MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation. Transplant International : Official Journal of the European Society for Organ Transplantation, 18(1), 65-72.
Santori G, et al. MELD Score Versus Conventional UNOS Status in Predicting Short-term Mortality After Liver Transplantation. Transpl Int. 2005;18(1):65-72. PubMed PMID: 15612986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation. AU - Santori,Gregorio, AU - Andorno,Enzo, AU - Morelli,Nicola, AU - Antonucci,Adelmo, AU - Bottino,Giuliano, AU - Mondello,Rosalia, AU - Castiglione,Andrea Gianelli, AU - Valente,Roberto, AU - Ravazzoni,Ferruccio, AU - Di Domenico,Stefano, AU - Valente,Umberto, PY - 2004/12/23/pubmed PY - 2005/7/7/medline PY - 2004/12/23/entrez SP - 65 EP - 72 JF - Transplant international : official journal of the European Society for Organ Transplantation JO - Transpl Int VL - 18 IS - 1 N2 - The Model for End-stage Liver Disease (MELD) provides a score able to predict short-term mortality in patients awaiting liver transplantation (LT). In the early 2002, United Network for Organ Sharing (UNOS) has proposed to replace the conventional statuses 3, 2B, and 2A with a modified MELD score. However, the accuracy of the MELD model to predict post-transplantation outcome is fairly elusive. In the present study we investigated the predictive value of the MELD score for short-term patient and graft mortality in comparison with conventional UNOS status. Sixty-nine patients listed at UNOS status 3 (n = 5), 2B (n = 55) or 2A (n = 9) who underwent LT were enrolled according to strict criteria. No donor-related parameters affected 3-month patient survival. Through univariate Cox regression, pretransplantation international normalized ratio (P = 0.049) and activated partial thromboplastin time (P = 0.032) were significantly associated with 3-month patient survival, although not in the subsequent multivariate analysis. The overall MELD score was 17 +/- 6.63 (median: 16, range: 4-34), increasing from UNOS Status 3 to 2A (r(2) = 0.171, P = 0.0001). No significant difference occurred in the median MELD score between patients who underwent a second LT and those who did not (P =0.458). The inter-rate agreement between UNOS status and MELD score after categorization for clinical urgency showed a fair agreement (kappa = 0.244). The 3-month patient and graft mortality was 15.94% and 20.29% respectively. The concordance statistic did not find significance between UNOS status and MELD score for 3-month patient (P = 0.283) or graft mortality (P = 0.957), although the MELD score revealed a major sensitivity for short-term patient mortality (0.637; 95%CI: 0.513-0.75). These findings suggest the need to implement MELD model accuracy for both inter-rate agreement with UNOS Status and patient outcome. SN - 0934-0874 UR - https://www.unboundmedicine.com/medline/citation/15612986/MELD_score_versus_conventional_UNOS_status_in_predicting_short_term_mortality_after_liver_transplantation_ L2 - http://link.springer.com/article/10.1111/j.1432-2277.2004.00024.x DB - PRIME DP - Unbound Medicine ER -