+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

The application of MELD score in patients submitted to liver transplantation: a retrospective analysis of survival and the predictive factors in the short and long term



The application of MELD score in patients submitted to liver transplantation: a retrospective analysis of survival and the predictive factors in the short and long term



Arquivos de Gastroenterologia 45(4): 275-283



The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. There are few reports studying the correlation between MELD and long-term posttransplantation survival. To assess the value of pretransplant MELD in the prediction of posttransplant survival. The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base. We excluded acute liver failure, retransplantation and reduced or split-livers. The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk. The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction). The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival. For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables. ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh. A total of 232 patients with 10 years follow up were available. The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 11.5. For MELD score > or =20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium. For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium. The regression univariated analyses came up with the following risk factors for death: score MELD > or = 25, blood requirements, recipient creatinine clearance pretransplant and age donor > or =50. After stepwise analyses, only red cell requirement was predictive. Patients with MELD score < 25 had a 68.86%, 50,44% and 41,50% chance for 1, 5 and 10-year survival and > or =25 were 39.13%, 29.81% and 22.36% respectively. Patients without hyponatremia were 65.16%, 50.28% and 41,98% and with hyponatremia 44.44%, 34.28% and 28.57% respectively. Patients with IDR > or =1.7 showed 53.7%, 27.71% and 13.85% and index donor risk <1.7 was 63.62%, 51.4% and 44.08%, respectively. Age donor > 50 years showed 38.4%, 26.21% and 13.1% and age donor < or =50 years showed 65.58%, 26.21% and 13.1%. Association with delta-MELD score did not show any significant difference. Expanded criteria donors were associated with primary non-function and severe liver dysfunction. Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium. In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 056239360

Download citation: RISBibTeXText

PMID: 19148354


Related references

The Application Of Meld Score In Patients Submitted To Liver Transplantation A Retrospective Analysis Of Survival And The Predictive Factors In The Short And Long Term. Transplantation 86(Suppl.): 155-156, 2008

The MELD score predicts the short-term and overall survival after liver transplantation in patients with primary sclerosing cholangitis or autoimmune liver diseases. Langenbeck's Archives of Surgery 399(8): 1001-1009, 2014

Application of the BAR score as a predictor of short- and long-term survival in liver transplantation patients. Hepatology International 9(1): 113-119, 2015

Potential predictive value of the MELD score for short-term mortality after liver transplantation. Transplantation Proceedings 36(3): 533-534, 2004

Does the patient selection with MELD score improve short-term survival in liver transplantation?. Arquivos Brasileiros de Cirurgia Digestiva 26(4): 324-327, 2013

Risk factors for short- and long-term mortality in liver transplant recipients with MELD score ≥30. Annals of Transplantation 20: 59-69, 2015

Use of BAR score as predictor of short and long-term survival of liver transplantation patients. Hepatology International 9(1): 3-4, 2015

MELD exceptions and new predictive score of death on long waiting lists for liver transplantation. Chirurgia 104(3): 267-273, 2009

The Donor-Risk-Index, ECD-Score and D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable sensitivity and specificity. Annals of Transplantation 17(3): 5-13, 2012

Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population. Journal of Transplantation 2016: 6787854, 2016

Prognostic factors for short and long-term survival in patients selected for liver transplantation. Medicina 41(1): 39-46, 2005

Liver transplantation for hepatocellular carcinoma in the MELD era: leading roles of MELD score, AFP level, and recipient age as predictors of survival. Digestive Diseases and Sciences 54(4): 917, 2009

Predicting Short- and Long-Term Outcomes in Adult Heart Transplantation: Clinical Utility of MELD-XI Score. Transplantation Proceedings 50(10): 3710-3714, 2018

MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation. Transplant International 18(1): 65-72, 2005

MELD-score compared to the Child-Pugh and the Emory-score for the prediction of long-term survival in patients undergoing transjugular intrahepatic portosystemic shunting. Hepatology 34(4 Pt 2): 183A, 2001