Comparison of the Child-Turcotte-Pugh Classification and the Model for End-stage Liver Disease Score as Predictors of the Severity of the Systemic Inflammatory Response in Patients Undergoing Living-donor Liver Transplantation

Abstract

The aim of this study was to evaluate and compare the Child-Turcotte-Pugh (CTP) classification system and the model for end-stage liver disease (MELD) score in predicting the severity of the systemic inflammatory response in living-donor liver transplantation patients. Recipients of liver graft were allocated to a recipient group (n = 39) and healthy donors to a donor group (n = 42). The association between the CTP classification, the MELD scores and perioperative cytokine concentrations in the recipient group was evaluated. The pro-inflammatory cytokines measured included interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α; the anti-inflammatory cytokines measured included IL-10 and IL-4. Cytokine concentrations were quantified using sandwich enzyme-linked immunoassays. The IL-6, TNF-α, and IL-10 concentrations in the recipient group were significantly higher than those in healthy donor group patients. All preoperative cytokine levels, except IL-6, increased in relation to the severity of liver disease, as measured by the CTP classification. Additionally, all cytokine levels, except IL-6, were significantly correlated preoperatively with MELD scores. However, the correlations diminished during the intraoperative period. The CTP classification and the MELD score are equally reliable in predicting the severity of the systemic inflammatory response, but only during the preoperative period.

Functional Capacity, Respiratory Muscle Strength, and Oxygen Consumption Predict Mortality in Patients with Cirrhosis

“…Regardless of their aetiology, patients with cirrhosis develop a progressive worsening of the disease that can be staged using clinical and/or mathematical parameters (i.e., the Child-Turcotte-Pugh score or the Model for End-Stage Liver Disease). Disease progression is linearly correlated with morbidity and mortality [ 1 ].…”

Fibrinolytic System Changes in Liver Surgery: A Pilot Observational Study

“…As a part of our preoperative routines, we evaluated the perioperative morbidity and mortality risks by means of the Child-Pugh score, which is widely used to assess the prognosis of patients with liver cirrhosis ( 25 ). With a score of less than 6 points, corresponding to a Child–Pugh class A, we predicted the one-year survival rate of our patients to 100% ( 26 , 27 ). Therefore, we considered the perioperative mortality risk as low, which we also confirmed by observing that no patient died or experienced serious complications during or after the surgery.…”

Pathophysiologic Implications of Cytokines Secretion during Liver Transplantation Surgery

“…Previous studies on cytokines secretion related to liver transplantation in patients with liver failure mostly focused on the types and subtypes of cytokines secreted during each stage of surgery 3, the serial changes in their concentrations during the surgery 4, and their relation to postoperative outcome after transplantation 5, 6. Additionally, several studies to elucidate the following issues have been done; factors influencing the secretion of cytokines during liver transplantation 7, 8, pro-inflammatory and anti-inflammatory cytokine balance during liver transplantation surgery 9, and the changes in the ratio of T helper 1 (Th 1) to T helper 2 (Th 2), and T helper 17 (Th 17) to regulatory T (Treg) cell signature cytokines during liver transplantation surgery with tools to change on the levels of Th 1, Th 2, Th17 and Treg cell signature cytokines 10. In this review article, we aim to introduce these studies regarding cytokines secretion during liver transplantation and to suggest study directions for better outcomes of the patients.…”