Karaciğer transplantasyon önceliğini belirlemede hangi model etkin; MELD skoru? CHILD Skoru?

Abstract

Background and Aims: Prioritization in liver transplantation is very important because of the ever-growing liver transplant waiting list and the shortage of deceased donors and even more new options of liver-living donors. The aim of our study was to evaluate the Child-Pugh and Model for End-Stage Liver Disease (MELD) scores with respect to their value in predicting the priority of liver transplantation, to prevent early transplantation and reduce waiting-list mortality. Materials and Methods: Patients diagnosed with end stage liver disease on the waiting list for liver transplant were included in this study. Prothrombin time, INR, serum albumin, bilirubin, urea, and creatinine levels were determined for measurement of Child- Pugh and MELD score. Child-Pugh and MELD values were calculated at baseline and in the follow-up period. All patients underwent abdominal ultrasonography for the detection of ascites. The grade of encephalopathy was noted. According to the Child-Pugh classification, the patients were categorized as A: 5 to 6, B: 7 to 9, and C: 10 to 15. MELD score was computed for each patient according to the original formula. MELD score was stratified into three groups: 0 to 10; 11 to 20; and 21 to 40. Student's t-test and correlation test were used for statistical analysis. Survival over the entire period was examined with Kaplan-Meier analysis (SPSS for Windows 10). Results: One hundred and ten patients (22 F, 88 M; mean age: 40.35±11.99, range: 16-64 years) on the transplant waiting list were evaluated retrospectively. During the follow-up, progression of both MELD and Child-Pugh scores was compared to the time of listing (r=0.687, p=0.01). While the mean survival time in the patients with Child A was 64 months, in Child C, mean survival was 24 months. While all patients with MELD score less than 10 points were alive, mean survival time was 50 months between 10-20 points, and 14 months for MELD score over 20 points. Conclusions: It was concluded that the MELD score seems more reliable than Child-Pugh with respect to selecting the priority of liver transplantation; however, more prospective studies are required. Analysis of many parameters for prioritization of liver transplantation is needed in our country, in view of the very low rate of donation of deceased organs.