Model for End-Stage Liver Disease (MELD) Score Does Not Predict Outcomes of Hepatitis B-Induced Acute-on-Chronic Liver Failure in Transplant Recipients

Background. Acute-on-chronic liver failure (ACLF) is a severe clinical entity and liver transplantation is the only definitive therapy to salvage these patients. However, the timing of liver transplant for these patients remains unclear. Methods. Seventy-eight patients undergoing liver transplantation because of hepatitis B ACLF were retrospectively analyzed from June 2004 to December 2010. The areas under the receiver operating characteristic curve (AUC) of Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) score for the post-transplantation outcomes were calculated. Results. The median age was 44 years (range, 25-64 years), serum bilirubin 418.53 mu mol/L (range, 112.90-971.40 mu mol/L), INR 3.177 (range, 1.470-9.850), and creatinine 70.84 mu mol/L (range, 12.39-844.1 mu mol/L); the median MELD score was 32 (range, 21-53) and CTP score 12 (8-15). The AUCs of MELD and CTP scores for 3-month mortality were 0.581 (95% confidence interval [CI], 0.421-0.742; sensitivity, 87.5%; specificity, 32.8%) and 0.547 (95% CI, 0.401-0.693; sensitivity, 75%; specificity, 41%), respectively. Meanwhile, there were no significant differences in hospital mortality (P = .252) or morbidity (P = .338) between the patients with MELD score >= 30 and those <30. Conclusions. MELD score had no predictive ability for the outcomes of patients with hepatitis B ACLF after orthotopic liver transplantation.