Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Brown, Robert S.; Kumar, K. Shiva; Russo, Mark W.; Kinkhabwala, Milan; Rudow, Dianne LaPointe; Harren, Patricia; Lobritto, Steven; Emond, Jean C.

doi:10.1053/jlts.2002.31340

Cited by 202 publications

(138 citation statements)

References 20 publications

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“…32,33 There is a paucity of data assessing the predictability of pre-OLT MELD score on post-OLT survival rate. 34,35 Although our study was not designed to evaluate the predictive capability of the MELD score for post-OLT survival, our data suggest a MELD score higher than 25 may be associated with a decrease in survival after re-OLT to less than 60%. This finding has significant implications and needs to be confirmed in prospective studies.…”

Section: Discussionmentioning

confidence: 90%

Poor survival after liver retransplantation: Is hepatitis C to blame?

Watt

Lyden

McCashland

2003

Liver Transplantation

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Data from 1990 to 1996 suggest that the prevalence of hepatitis C virus (HCV) infection in repeated orthotopic liver transplantation (re-OLT) is increasing, and patient survival may be worse. Aims of the study are to: (1) assess the prevalence of HCV in re-OLT, (2) compare survival between primary OLT and re-OLT for HCV versus non-HCV diseases, and (3) evaluate Model for End-Stage Liver Disease (MELD) scores in re-OLT. The United Network for Organ Sharing database for adult patients undergoing primary OLT or re-OLT from January 1996 to June 2002 was analyzed. Patients with malignancy or those who underwent re-OLT within 30 days of primary OLT were excluded. A total of 22,120 primary OLTs and 2,129 reOLTs were performed. HCV was noted in 9,564 primary OLTs (43.2%) and 899 re-OLTs (42.2%). Overall 1, 3, and 5-year patient survival rates were 86%, 79%, and 73% for primary OLT, but 67%, 56%, and 52% for re-OLT (P < .001). Survival rates of patients with HCV at 1, 3, and 5 years were 86%, 76%, and 68% for primary OLT and 61%, 50%, and 45% for re-OLT (P < .001). Survival was less for patients with HCV compared with those with autoimmune hepatitis (AIH) and hepatitis B for re-OLT (P < .01). However, survival after re-OLT was no different for those with HCV than for those with all other causes. MELD scores between 11 and 20 were the most common for re-OLT. A marked decreased in survival was noted in all patients who underwent re-OLT with MELD scores greater than 25. HCV prevalence in OLT has reached a plateau in recent years. Survival after re-OLT is inferior to that for primary OLT, but re-OLT survival appears to have improved. Survival after re-OLT is lower in patients with HCV compared with those with AIH and hepatitis B, but no different than for those with most other liver diseases. Survival appeared worse in patients who underwent re-OLT with a MELD score greater than 25. (Liver Transpl 2003;9:1019-1024.) R ecurrence of hepatitis C virus (HCV) after orthotopic liver transplantation (OLT) is almost universal. [1][2][3][4] Recent data suggest that in approximately 20% of HCV-related transplantations, allograft cirrhosis develops within 5 years. 5-9 HCV-related re-OLT increased significantly throughout the early 1990s, 10 but there are no recent prevalence data to show if this trend continues.Patient survival after primary OLT for HCV infection throughout the 1990s was similar to that for most other indications for OLT. [11][12][13] However, a recent study by Forman et al 14 showed an increased rate of death and allograft failure in HCV-positive compared with HCV-negative transplant recipients. 14 In general, re-OLT has a lower survival rate than primary OLT. [15][16][17] In small studies, patient survival after re-OLT for HCV was not different compared with re-OLT for other causes. 1,3,12,18 Conversely, several other studies suggested that survival after re-OLT for HCV is significantly worse than that for non-HCV-related indications. 10,[19][20][21] These studies also suggested that survival is worse in patients wit...

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Section: Discussionmentioning

confidence: 90%

Poor survival after liver retransplantation: Is hepatitis C to blame?

Watt

Lyden

McCashland

2003

Liver Transplantation

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“…9 Another study of 42 status 2A patients did not find MELD scores predictive of short-term survival. 10 However, a retrospective study of 669 patients found higher MELD score correlated well with decreased 1-and 2-year survival when patients were stratified into three groups (MELD score Ͻ15, 15 to 24, and Ͼ24). 11 Differences in survival between groups were statistically significant for patients with hepatitis C and noncholestatic liver disease only.…”

Section: Discussionmentioning

confidence: 99%

Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients

Hayashi

Forman

Steinberg

et al. 2003

Liver Transplantation

102

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A dult-to-adult right hepatic lobe living donor liver transplantation (LDLT) has grown rapidly in the setting of a cadaveric organ shortage. 1 Initial outcomes have been promising for both recipients and donors. 2,3 Nevertheless, this treatment must be approached with careful forethought. Criteria for both recipient and donor selection are just evolving. United Network of Organ Sharing (UNOS) status 2A proved to be an important recipient exclusionary criterion because such patients have threefold greater mortality compared with recipients of cadaveric livers. 4 In February 2002, the national organ allocation policy for liver transplantation changed. As a result, the priority for liver transplantation is currently based on the Model for End-Stage Liver Disease (MELD) score, which is a whole-number score derived from objective laboratory values. Unfortunately, there are no data regarding outcomes for living donor liver transplant recipients based on MELD score. Based on the poor outcomes in status 2A transplant recipients, we were concerned that high MELD scores would be associated with poor outcomes after LDLT. Therefore, we retrospectively analyzed the short-term outcomes (post-LDLT hospitalization days, 1-year patient and graft survival) in 62 living donor liver transplant recipients relative to MELD scores. Because the MELD score is designed to predict short-term mortality, we believed a high preoperative MELD score may predict greater postoperative morbidity and mortality. Methods PatientsWe retrospectively analyzed all adult living donor liver transplant recipients at the University of Colorado Health Sciences Center in Denver between August 1997 and March 2002. We excluded patients with fulminant hepatic failure. MELD ScoresThe most recent pretransplantation internationalized normalized ratio and bilirubin and creatinine levels were used to calculate a MELD score for each patient. Scores were calcuFrom the *Divisions

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“…Some studies have found that the pretransplant MELD score had a significant influence on survival during the first 2 postoperative years, 9,10 whereas other investigators have questioned its value as a tool to predict both posttransplant outcome and survival. 7,11 In this study, we also investigated the predictive value of the MELD score before OLT and on recipient postoperative outcomes. Our results indicate that a higher pretransplant MELD score was significantly associated with higher intraoperative RBC and FFP use as well as increased postoperative total bilirubin levels, LOHS, and 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function

et al. 2007

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Previous studies have shown that donor hypernatremia and possibly recipient hyponatremia negatively impact graft function after orthotopic liver transplant (OLT). The purpose of this retrospective investigation was to determine whether measured differences in serum sodium values between cadaveric donors and OLT recipients (⌬Na ϩ ) influence immediate postoperative allograft function and short-term patient outcomes. Two hundred and fifty patients that underwent OLT from January 2001 to December 2005 were included in this study. The ⌬Na ϩ for each donor recipient pair was correlated with standard postoperative liver function tests as well as recipient length of intensive care unit stay (LOICUS), length of hospital stay (LOHS) and recipient survival. The relationship between donor hypernatremia (serum sodium Ն 155 mEq/mL), recipient hyponatremia (serum sodium level Յ 130 mEq/mL), and postoperative outcomes were analyzed as well. Adjustments were made for baseline potential confounders, including model for end-stage liver disease (MELD) score, preservation solution used (HTK vs. UW), recipient and donor demographics and cold ischemia time (CIT). ⌬Na ϩ as well as donor hypernatremia and recipient hyponatremia were not found to be associated with immediate postoperative allograft function, intraoperative blood product usage, LOICUS, LOHS or short-term patient survival. However, both the preoperative MELD score and HTK preservation solution used were significantly associated with several patient outcomes. A higher MELD score was associated with both increased red blood cell (RBC) (P Ͻ 0.001) and fresh frozen plasma (FFP) usage (P ϭ 0.002), elevated postoperative total bilirubin levels (P Ͻ 0.001), increased LOHS (P ϭ 0.04), and a higher 30-day post transplant mortality (P ϭ 0.02). The use of HTK preservation solution was associated with higher mean postoperative aspartate aminotransferase levels (P ϭ 0.02) and decreased mean RBC (P Ͻ 0.001) and FFP usage (P ϭ 0.009) compared to UW preservation solution use. Liver Transpl 14: 59-65, 2008.

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Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Cited by 202 publications

References 20 publications

Poor survival after liver retransplantation: Is hepatitis C to blame?

Poor survival after liver retransplantation: Is hepatitis C to blame?

Model for End-Stage Liver Disease score does not predict patient or graft survival in living donor liver transplant recipients

Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function

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