Predicting outcome after liver transplantation: utility of the model for end-stage liver disease and a newly derived discrimination function1

Desai, Niraj M.; Mange, Kevin C.; Crawford, Michael; Abt, Peter L.; Frank, Adam M.; Markmann, Joseph W.; Velidedeoğlu, Ergun; Chapman, William C.; Markmann, James F.

doi:10.1097/01.tp.0000101009.91516.fc

Cited by 245 publications

(205 citation statements)

References 29 publications

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“…Another group compared MELD versus Child for the same purpose favoring the first one ( -statistic < 0.7) [9,18]. Some authors stated that a MELD score >25 has AUROC of 0.54 and 0.55 for predicting patient survival following 3 and 12 months of transplantation [19], while other groups behalf similar survival prediction (AUROC of 0.58, 0.67, and <0.61) [20]. Most of these studies did not include a pure cohort of cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Lower survival rates in patients with higher MELD scores have been assessed before [7,8]. However, the performance of MELD in prediction of post-LT events has been explored with poor results [7][8][9][10][11][12][13][14]. Outcomes after transplantation depend on a number of pre-and post-LT factors, which include both recipient and donor fitness, surgeon's skills, and transplant unit team's experience.…”

Section: Introductionmentioning

confidence: 99%

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Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina

Piñero

Marciano

Villamil

et al. 2013

ISRN Transplantation

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Background. MELD or MELD sodium promotes sicker patients for earlier liver transplantation (LT); the balance between pre-and post-LT outcomes is still controversial. Aim. To compare MELD and related scores' risk assessment of short-term morbidity and mortality after LT. Methods. We included only transplanted cirrhotic patients from 6/2005 to 6/2010 ( = 152). Immediate pre-LT MELD, integrated MELD (iMELD), and two MELD sodium formulas "MELD Na1" and "MELDNa2" were calculated. Results. Pre-LT scores for nonsurvivors were higher than those for survivors: MELD (28 ± 8 versus 22 ± 7, = 0.005), MELD Na1 (33 ± 8 versus 27 ± 10, = 0.039), and iMELD (51 ± 6 versus 46 ± 8, = 0.018). Patient survival assessment was performed by AUROC analysis (95% CI): MELD 0.694 (0.56-0.82; = 0.006), MELD Na1 0.682 (0.56-0.79; = 0.046), MELD Na2 0.651 (0.54-0.76; = NS), and iMELD 0.698 (0.593-0.80; = 0.022). Patients with MELD ≥25 points had longer intensive care stay (mean 10 versus 7 days, = 0.015) and longer mechanical ventilatory support (5.4 versus 1.9 days, = 0.022). Conclusions. The addition of serum sodium to MELD does not improve assessment of mortality after LT. Patients with higher MELD may preclude higher morbidity after transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina

Piñero

Marciano

Villamil

et al. 2013

ISRN Transplantation

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“…16 To develop a liver graft allocation system that incorporates the principle of utility, the development of a model that predicts posttransplant outcomes is necessary. Since MELD or CTP scores are unable to accurately predict postoperative patient survival, [5][6][7]12 identification of preoperative parameters that correlate with outcomes is mandatory. Indeed, it seems implausible that any system, which needs to combine justice and utility in liver graft allocation, would not include donor or other variables that have been shown to be important.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the MELD score was unable to predict early (90-d) postoperative mortality in almost all of the relevant studies. [5][6][7] To increase their accuracy, the most recent models for the prediction of early postoperative mortality have included the MELD score and many other variables, such as serum sodium, 8 donor quality 9 or serum cholinesterase. 10 Prediction of long-term survival alone after liver transplantation is less well studied.…”

Section: Discussionmentioning

confidence: 99%

Association of preoperative parameters with postoperative mortality and long-term survival after liver transplantation

Vrochides

Hassanain

Barkun

et al. 2011

cjs

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Background:The ability of Child-Turcotte-Pugh (CTP) or Model for End-Stage Liver Disease (MELD) scores to predict recipient survival after liver transplantation is controversial. This analysis aims to identify preoperative parameters that might be associated with early postoperative mortality and long-term survival after liver transplantation. Methods:We studied a total of 15 parameters, using both univariate and multivariate models, among adults who underwent primary liver transplantation.Results: A total of 458 primary adult liver transplants were performed. Fifty-seven (12.44%) patients died during the first 3 postoperative months and composed the early mortality group. The remaining 401 patients composed the long-term patient survival group. The parameters that were identified through univariate analysis to be associated with early postoperative mortality were CTP score, MELD score, bilirubin, creatinine, international normalized ratio and warm ischemia time (WIT). In all multivariate models, WIT retained its statistical significance. The 10-year long-term survival was 65%. The parameters that were identified to be independent predictors of long-term survival were the recipient's sex (improved survival in women, p = 0.005), diagnosis of hepatocellular cancer (p = 0.015) and recipient's age (p = 0.024). Conclusion:Either CTP or MELD score, in conjunction with WIT, might have a role in predicting early postoperative mortality after liver transplantation, whereas the recipient's sex and the absence of hepatocellular cancer are associated with improved long-term survival.

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“…31 Several recipient characteristics can increase the risk of poor DCD outcomes, including high Model for End-stage Liver Disease scores, which have been associated with graft failure and biliary complications in some studies, whereas other studies refute this claim. 26,38,39 In addition, hepatitis C viruspositive recipients may be at increased risk for hepatitis C virus recurrence. 40,41 Recently, Croome and associates found that transplant recipients with hepatocellular carcinoma may have inferior survival rates after DCD transplant (P = .049).…”

mentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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The supply of liver grafts for treatment of end-stage liver disease continues to fall short of ongoing demands. Currently, most liver transplants originate from donations after brain death. Enhanced utilization of the present resources is prudent to address the needs of the population. Donation after circulatory or cardiac death is a mechanism whereby the availability of organs can be expanded. Donations after circulatory death pose unique challenges given their exposure to warm ischemia. Technical principles of donations after circulatory death procurement and pertinent studies investigating patient outcomes, graft outcomes, and complications are highlighted in this review. We also review associated risk factors to suggest potential avenues to achieve improved outcomes and reduced complications. Future considerations and alternative techniques of organ preservation are discussed, which may suggest novel strategies to enhance preservation and donor expansion through the use of marginal donors. Ultimately, without effective measures to bolster organ supply, donations after circulatory death should remain a consideration; however, an understanding of inherent risks and limitations is necessary.

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Predicting outcome after liver transplantation: utility of the model for end-stage liver disease and a newly derived discrimination function1

Cited by 245 publications

References 29 publications

Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina

Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina

Association of preoperative parameters with postoperative mortality and long-term survival after liver transplantation

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