Pretransplant MELD score as a predictor of outcome after liver transplantation for chronic hepatitis C

被引:61
作者
Onaca, NN [1 ]
Levy, MF [1 ]
Netto, GJ [1 ]
Thomas, MJ [1 ]
Sanchez, EQ [1 ]
Chinnakotla, S [1 ]
Fasola, CG [1 ]
Weinstein, JS [1 ]
Murray, N [1 ]
Goldstein, RM [1 ]
Klintmalm, GB [1 ]
机构
[1] Baylor Univ, Med Ctr, Transplantat Serv, Dallas, TX USA
关键词
hepatitis C; liver transplantation; outcome; severity score;
D O I
10.1034/j.1600-6143.2003.00092.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The Model of End-Stage Liver Disease (MELD) score, an accurate predictor of mortality in patients awaiting liver transplantation (OLTX), did not predict graft or patient survival in the post-transplant setting. Our aim was to test the model in patients who underwent OLTX for chronic hepatitis C. Two hundred and eighty-seven adult patients who underwent primary OLTX for chronic hepatitis C between December 1993 and September 1999 were studied from a prospectively maintained database. The group was stratified by MELD scores of less than 15, 15-24, and greater than 24. Patient survival, graft survival, and interval liver biopsy pathology were reviewed. Both patient and graft survival at 3, 6, and 12 months were significantly lower in the higher MELD score groups, as was patient survival at 24 months (p-values, 0.01-0.05). The difference in survival between the low, medium, and high MELD score groups increases in time. The survival without bridging fibrosis in the allograft at 1 year post-transplant was significantly lower with higher MELD scores (p = 0.037). The decrease in survival seen in hepatitis C patients with MELD scores greater than 24 raises questions of transplant suitability for these patients. Therapeutic modalities to decrease post-transplant graft injury in these patients should be explored.
引用
收藏
页码:626 / 630
页数:5
相关论文
共 20 条
[1]   Hepatitis C virus recurrence after liver transplantation [J].
Bizollon, T ;
Ducerf, C ;
Trepo, C ;
Mutimer, D .
GUT, 1999, 44 (04) :575-578
[2]   Transplantation in HCV: whither immunosuppression [J].
Bizollon, T ;
Trepo, C .
GUT, 1999, 45 (03) :327-328
[3]  
COLQUHOUN S, 1999, ANN SURG, V229, P824
[4]  
DESMET VJ, 1994, HEPATOLOGY, V19, P1513, DOI 10.1002/hep.1840190629
[5]  
EDWARDS EB, 2001, LIVER TRANSPLANT, V7, P567
[6]  
FLORA KD, 1998, TRANSPLANTATION, V65, P1178
[7]   Predicting the prognosis of chronic liver disease: An evolution from child to MELD [J].
Forman, LM ;
Lucey, MR .
HEPATOLOGY, 2001, 33 (02) :473-475
[8]  
IRISH W, 1998, LIVER TRANSPLANT SUR, V4, pB44
[9]  
KAMATH PS, 2001, HEPATOLOGY, V34, pA235
[10]  
KINKHABWALA M, 2002, LIVER TRANSPLANT, V8, P278