COMPARISON OF CHILD-TURCOTTE-PUGH AND PELD SCORES FOR PREDICTING SHORT TERM OUTCOME OF LIVING- RELATED PEDIATRIC LIVER TRANSPLANTATION

Abstract

Introduction: Several prognostic parameters for chronic liver diseases in children have been advocated during the past few decades. The Pediatric End- Stage Liver Disease (PELD) model is a new model for scoring pediatric liver disease severity. The PELD scoring system uses objective and standardized laboratory values rather than clinical findings to avoid interobserver or interinstitutional variability. We first aimed to compare PELD scoring system with Child-Turcotte-Pugh (CPT) scoring system to evaluate the severity of liver disease before liver transplantation. Our second aim was to test the validity of PELD and CPT scores to predict short-term outcome of living- related liver transplantation (LRLT) in children. Patients and Methods: 23 children (8 female) underwent LRLT between 2001-2004. Patients transplanted for fulminant liver failure were excluded. PELD score was calculated using the United Network for Organ Sharing formula. CPT and PELD scores were calculated the day of transplantation and correlated with patient survival. Patients were allocated into three groups according to PELD scores namely less than 15, 15-25 and higher than 25.TableResults: Mean±SD age at transplantation was 81.7±63.4 months (range 12-204 months). Indications of LRLT were Wilson's disease (n = 9), genetic cholestatic liver diseases (n = 6), biliary atresia (n = 5), tyrosinemia and hepatocellular carcinoma (n = 2), Caroli syndrome (n = 1). The numbers of patients according to CPT classification were as following; class A (n = 4), class B (n = 14), and class C (n = 5). Eleven patients had a PELD score less than 15. PELD scores were between 15-25 in 6, and higher than 25 in 6 patients. Mean ± SD values of PELD and CPT scores were 17 ± 14 (range -8 to 58) and 8 ± 2 (range 5 to 12) respectively. There was a strong positive correlation between PELD and CPT scores to assess severity of liver disease (r = 0.80, p = 0.000). Median follow-up time was 7 months (2 to 40 months). During this period 2 patients died because of sepsis. Overall 3 and 6 months survival was 90% and 88.9% respectively. Post transplantation survival at 3 and 6 months did not significantly different among the 3 PELD subgroups. CPT class A, B, C patients were also similar in terms of 3 and 6 months of survival. Conclusion: PELD scoring system is comparable to CPT scoring system to evaluate severity of end stage liver disease. Both pretransplant PELD and CPT scores did not predict short-term outcome after pediatric living related liver transplantation.