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MELD and prediction of post-liver transplantation survival.

Abstract

The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. It has since become the standard tool to prioritize patients for liver transplantation. We assessed the value of pretransplant MELD in the prediction of posttransplant survival. We identified adult patients who underwent liver transplantation at our institution during 1991-2002. Among 2,009 recipients, 1,472 met the inclusion criteria. Based on pretransplant MELD scores, recipients were stratified as low risk (< or = 15), medium risk (16-25), and high risk (>25). The primary endpoints were patient and graft survival. Mean posttransplant follow-up was 5.5 years. One-, 5- and 10-year patient survival was 83%, 72%, and 58%, respectively, and graft survival was 76%, 65%, and 53%, respectively. In univariable analysis, patient and donor age, patient sex, MELD score, disease etiology, and retransplantation were associated with posttransplantation patient and graft survival. In multivariable analysis adjusted for year of transplantation, patient age >65 years, donor age >50 years, male sex, and retransplantation and pretransplant MELD scores >25 were associated with poor patient and graft survival. The impact of MELD score >25 was maximal during the first year posttransplant. In conclusion, older patient and donor age, male sex of recipient, retransplantation, and high pretransplant MELD score are associated with poor posttransplant outcome. Pretransplant MELD scores correlate inversely with posttransplant survival. However, better prognostic models are needed that would provide an overall assessment of transplant benefit relative to the severity of hepatic dysfunction.

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  • Authors+Show Affiliations

    ,

    Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.

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    Source

    MeSH

    Adult
    Age Distribution
    Cause of Death
    Female
    Graft Rejection
    Graft Survival
    Humans
    Liver Transplantation
    Male
    Middle Aged
    Multivariate Analysis
    Postoperative Complications
    Predictive Value of Tests
    Probability
    Proportional Hazards Models
    Retrospective Studies
    Risk Assessment
    Sex Distribution
    Survival Analysis
    Transplantation Immunology
    United States

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    16498643

    Citation

    Habib, Shahid, et al. "MELD and Prediction of Post-liver Transplantation Survival." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 12, no. 3, 2006, pp. 440-7.
    Habib S, Berk B, Chang CC, et al. MELD and prediction of post-liver transplantation survival. Liver Transpl. 2006;12(3):440-7.
    Habib, S., Berk, B., Chang, C. C., Demetris, A. J., Fontes, P., Dvorchik, I., ... Shakil, A. O. (2006). MELD and prediction of post-liver transplantation survival. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 12(3), pp. 440-7.
    Habib S, et al. MELD and Prediction of Post-liver Transplantation Survival. Liver Transpl. 2006;12(3):440-7. PubMed PMID: 16498643.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - MELD and prediction of post-liver transplantation survival. AU - Habib,Shahid, AU - Berk,Brian, AU - Chang,Chung-Chou H, AU - Demetris,Anthony J, AU - Fontes,Paulo, AU - Dvorchik,Igor, AU - Eghtesad,Bijan, AU - Marcos,Amadeo, AU - Shakil,A Obaid, PY - 2006/2/25/pubmed PY - 2006/8/5/medline PY - 2006/2/25/entrez SP - 440 EP - 7 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 12 IS - 3 N2 - The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. It has since become the standard tool to prioritize patients for liver transplantation. We assessed the value of pretransplant MELD in the prediction of posttransplant survival. We identified adult patients who underwent liver transplantation at our institution during 1991-2002. Among 2,009 recipients, 1,472 met the inclusion criteria. Based on pretransplant MELD scores, recipients were stratified as low risk (< or = 15), medium risk (16-25), and high risk (>25). The primary endpoints were patient and graft survival. Mean posttransplant follow-up was 5.5 years. One-, 5- and 10-year patient survival was 83%, 72%, and 58%, respectively, and graft survival was 76%, 65%, and 53%, respectively. In univariable analysis, patient and donor age, patient sex, MELD score, disease etiology, and retransplantation were associated with posttransplantation patient and graft survival. In multivariable analysis adjusted for year of transplantation, patient age >65 years, donor age >50 years, male sex, and retransplantation and pretransplant MELD scores >25 were associated with poor patient and graft survival. The impact of MELD score >25 was maximal during the first year posttransplant. In conclusion, older patient and donor age, male sex of recipient, retransplantation, and high pretransplant MELD score are associated with poor posttransplant outcome. Pretransplant MELD scores correlate inversely with posttransplant survival. However, better prognostic models are needed that would provide an overall assessment of transplant benefit relative to the severity of hepatic dysfunction. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/16498643/MELD_and_prediction_of_post_liver_transplantation_survival_ L2 - https://doi.org/10.1002/lt.20721 DB - PRIME DP - Unbound Medicine ER -