Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

Abstract

. We used analysis of area under ROC (receiver operating characteristic) as a summary measure of the performance of the MELD score and assessed predictors of medium-term survival using univariate and multivariate analysis. Results Results ResultsResults Results: The cumulative survival of three, six, 12 and 24 months of the 208 patients studied was 85.1%, 79.3%, 74.5% and 71.1%, respectively. The preoperative MELD score showed a low discriminatory power for predicting survival after TH. By univariate analysis, we identified intraoperative transfusion of red blood cells (p <0.001) and platelets (p = 0.004) and type of venous hepatocaval anastomosis (p = 0.008) as significantly related to medium-term survival of the patients studied. However, by multivariate analysis only red blood cell transfusion was a significant independent predictor of outcome. Conclusion Conclusion Conclusion Conclusion Conclusion: The MELD score showed low overall accuracy for predicting post-transplant survival of patients studied, among which only intraoperative transfusion of red blood cells was identified as an independent predictor of survival in the medium term after TH.

Impacto do escore MELD na sobrevida de pacientes portadores de carcinoma hepatocelular, transplantados no Brasil: revisão sistemática.

“…Results have shown that a pre-LT MELD of 26 has been associated with worse survival in short-and long-term (10 years) post-LT 19 . Studies conducted in Brazil, such as those by Brandão et al 13 and Batista et al 15 Freitas et al 14 Aranzana et al 18 compared, in a cohort of 164 patients with HCC (16.3%), the areas under ROC curve for post-transplant survival for MELD score at one year and two years after transplantation.…”

“…One study (0.6%) was excluded because it was a duplicate. At the end, six articles (3.7%) were eligible for the qualitative analysis (Table 1) [13][14][15][16][17][18] .…”

“…However, the percentage did not refer exclusively to patients with HCC. Regarding mediumand long-term predictive capacity, Brazilian studies found a low discriminatory power of the score with post-LT survival13,15,16 .Inthe United States, United Kingdom, and Ireland, MELD prognostic model is significantly associated with post-LT survival, but with low predictive capacity in medium-and long-terms, suggesting a combination of MELD score with a post-transplant survival model to be properly developed and validated 4 . Despite the consensus among researchers on the urgency of the analysis of the predictive value of the post-LT MELD score 6,10 , we observed a lack of articles in literature on the role of this model on post-LT medium-and long-term survival in patients with HCC.…”

The Impact of the Meld Score on Liver Transplant Allocation and Results: An Integrative Review

“…Blood transfusion is also linked to reduced survival after transplantation 2 , 11 , with an association between multiple transfusions and complications seen as a predictor of survival 3 . …”

“…The need for blood transfusion may also be related to the severity of the condition of the patient at the time of the transplant surgery, in which cases a lower survival rate was already expected 2 , 19 .…”