Predicting short-term survival after liver transplantation on eight score systems: a national report from China Liver Transplant Registry

Qi Ling,Tian Shen,Weilin Wang,Xiao Xu,Runzhou Zhuang,Haojiang Dai,Shusen Zheng

doi:10.1038/srep42253

Abstract

To compare the performance of eight score systems (MELD, uMELD, MELD-Na. iMELD, UKELD, MELD-AS, CTP, and mCTP) in predicting the post-transplant mortality, we analyzed the data of 6,014 adult cirrhotic patients who underwent liver transplantation between January 2003 and December 2010 from the China Liver Transplant Registry database. In hepatitis B virus (HBV) group, MELD, uMELD and MELD-AS showed good predictive accuracies at 3-month mortality after liver transplantation; by comparison with other five models, MELD presented the best ability in predicting 3-month, 6-month and 1-year mortality, showing a significantly better predictive ability than UKELD and iMELD. In hepatitis C virus and Alcohol groups, the predictive ability did not differ significantly between MELD and other models. Patient survivals in different MELD categories were of statistically significant difference. Among patients with MELD score >35, a new prognostic model based on serum creatinine, need for hemodialysis and moderate ascites could identify the sickest one. In conclusion, MELD is superior to other score systems in predicting short-term post-transplant survival in patients with HBV-related liver disease. Among patients with MELD score >35, a new prognostic model can identify the sickest patients who should be excluded from waiting list to prevent wasteful transplantation.

Highlights

In the present study, we aim to evaluate the efficacy of pre-transplant MELD and other scoring systems in the prediction of post-transplant survival using a large cohort of patients from the China Liver Transplant Registry (CLTR) database
MELD presented the highest area under the receiver operating characteristic curve (AUROC) at different time periods after transplantation, followed by updated MELD (uMELD), MELD-AS and MELD-Na, which represented almost similar predictive accuracies compared with MELD
There is a general consensus that MELD scoring system is an excellent predictor of patient mortality on the waiting list, it remains controversial that whether the pre-transplant MELD score could be a predictor of post-transplant survival as summarized by a systematic review[14]

Summary

Introduction

We aim to evaluate the efficacy of pre-transplant MELD and other scoring systems in the prediction of post-transplant survival using a large cohort of patients from the China Liver Transplant Registry (CLTR) database. We excluded those who underwent re-transplantation (n = 449) or combined liver-kidney transplantation (n = 185), or had hepatocellular carcinoma (n = 7,146). Another 762 patients were not accounted because of incomplete laboratory and clinical data. This study was approved by the Scientific Committee of CLTR (Approval No 458; http://www.cltr.org/), which was authorized as the only national liver transplantation registry in Mainland China by the Ministry of Health. Creatinine was set at 4 if the patient was receiving renal replacement therapy

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