Model for end-stage liver disease versus the Child-Pugh score in predicting the post-transplant 3-month and 1-year mortality in a cohort of Chinese recipients

Guo, Zhiyong; He, Xiaoshun; Wu, Linwei; Wang, Ju; Hu, Anbin; Tai, Qiang; Wang, Dongping; Ma, Yu; Wang, Guodong; Zhu, Xiao-feng

doi:10.1007/s00595-009-4114-6

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…In addition, the liver graft at risk for preservation injury, rejection, recurrent viral disease and other types of injury may be even more sensitive to diminished right ventricular function. The association of pre-LT RRT, PASP on echocardiography and MELD score with adverse short-term postoperative outcomes has been reported previously (2,3,(12)(13)(14). Specifically, the presence of elevated PASP on echocardiography was shown to have an effect on short-term post-LT outcomes (2,3).…”

Section: Discussionmentioning

confidence: 57%

Role of Pretransplant Echocardiographic Evaluation in Predicting Outcomes Following Liver Transplantation

Kia

Shah

Wang

et al. 2013

American Journal of Transplantation

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Maintenance of cardiac function is critical to the survival of patients with end-stage liver disease after liver transplantation (LT). We sought to determine whether pre-LT echocardiographic indices of right heart structure and function were independently predictive of morbidity and mortality post-LT. We retrospectively studied 216 consecutive patients who underwent pre-LT 2-dimensional/Doppler echocardiography with subsequent LT from 2007 to 2010. A blinded reader analyzed multiple echocardiographic parameters, including right ventricular structure and function, pulmonary artery systolic pressure (PASP) and the presence and severity of tricuspid regurgitation (TR). On univariate analysis, Model of End-Stage Liver Disease (MELD) score, PASP, presence of !mild TR, post-operative renal replacement therapy (RRT) and spontaneous bacterial peritonitis were found to be significant predictors of adverse outcomes. On multivariate analysis, only !mild TR was found to predict both patient mortality (p ¼ 0.0024, HR ¼ 3.91, 95% CI: 1.62-9.44) and graft failure (p ¼ 0.0010, HR ¼ 3.70, 95% CI: 1.70-8.06). PASP and MELD correlated with post-LT intensive care unit length of stay (LOS) and, along with hemodialysis, were associated with hospital LOS and time on ventilator. In conclusion, pre-LT echocardiographic assessments of the right heart may be useful in predicting post-LT morbidity and mortality and guiding the selection of appropriate LT candidates.

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Section: Discussionmentioning

confidence: 57%

Role of Pretransplant Echocardiographic Evaluation in Predicting Outcomes Following Liver Transplantation

Kia

Shah

Wang

et al. 2013

American Journal of Transplantation

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“…In 1 study, the cstatistic decreased over time, from 0.711 for 3-month posttransplant survival to 0.679 for 12-month survival [8]. In the single study with a high c-statistic [9], there was no clear difference in sample size, follow-up time, or patient population when compared to the studies with lower values.…”

Section: Predictive Ability Of Meld Score For Posttransplantation Surmentioning

confidence: 89%

Predicting Survival after Liver Transplantation Based on Pre-Transplant MELD Score: a Systematic Review of the Literature

2013

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The model for end-stage liver disease (MELD) score is used to stratify candidates for liver transplantation based on objective measures of disease severity. MELD has been validated as a predictor of wait-list mortality in transplantation candidates and has been postulated as a predictor of post-transplant survival. The purpose of this study was to examine the predictive value of the pre-transplantation MELD score on post-transplant survival from relevant existing studies. A systematic review and critical appraisal was performed using Cochrane guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were searched for articles published in the English language since 2005 using a structured search strategy. There were 3058 discrete citations identified and screened for possible inclusion. Any study examining the relationship between pre-transplant MELD and post-transplant survival in the general transplant population was included. Thirty-seven studies met these criteria and were included in the review. Studies were all case series that typically involved stratified analyses of survival by MELD. They represented 15 countries and a total of 53,691 patients. There was significant clinical heterogeneity in patient populations across studies, which precluded performance of a meta-analysis. In 15 studies, no statistically significant association between MELD and post-transplant survival was found. In the remaining 22, some association was found. Eleven studies also measured predictive ability with c-statistics. Values were below 0.7 in all but two studies, suggesting poor predictive value. In summary, while the majority of studies reported an association between pre-transplantation MELD score and post-transplant survival, they represented a low level of evidence. Therefore, their findings should be interpreted conservatively.

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“…Previous studies have demonstrated MELD and CTP to be equivalent in predicting the short-and intermediate-term mortality in patients with cirrhosis and those undergoing TIPS while others have shown MELD to have superior predictive accuracy for 12-and 24-months survival. [3][4][5][6][7][8][9]29 In this study, we have not only shown that MELD as a disease severity index is superior to CTP for both short-term and intermediate-term, but also demonstrated excellent diagnostic accuracy of MELD in predicting 1-, 3-, and 6-months mortality (c-statistics 0.920, 0.967, and 0.977, respectively). One reason for the superior predictive ability of MELD compared with CTP is the inclusion of serum creatinine.…”

Section: Discussionmentioning

confidence: 60%

Predicting Mortality Across a Broad Spectrum of Liver Disease—An Assessment of Model for End-Stage Liver Disease (MELD), Child–Turcotte–Pugh (CTP), and Creatinine-Modified CTP Scores

Chawla¹,

Kashinath²,

Duseja³

et al. 2011

Journal of Clinical and Experimental Hepatology

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Model for end-stage liver disease versus the Child-Pugh score in predicting the post-transplant 3-month and 1-year mortality in a cohort of Chinese recipients

Cited by 10 publications

References 27 publications

Role of Pretransplant Echocardiographic Evaluation in Predicting Outcomes Following Liver Transplantation

Role of Pretransplant Echocardiographic Evaluation in Predicting Outcomes Following Liver Transplantation

Predicting Survival after Liver Transplantation Based on Pre-Transplant MELD Score: a Systematic Review of the Literature

Predicting Mortality Across a Broad Spectrum of Liver Disease—An Assessment of Model for End-Stage Liver Disease (MELD), Child–Turcotte–Pugh (CTP), and Creatinine-Modified CTP Scores

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