The value of MELD-Na score in predicting complication severity grades after orthotopic liver transplantation for severe hepatitis

Abstract

Objective To study the value of preoperative MELD-Na score (Model for End-Stage Liver Disease-Sodium) in predicting complication severity grades after liver transplantation (LT) for severe hepatitis. Methods Patients who underwent LT for severe hepatitis between August 1, 2004, and September 1, 2014 were retrospectively studied. The Accordion severity grading system was used to classify the complication severity grades after LT. The grades were classified as grade 1 (mild), grade 2 (moderate), grade 3-5 (severe), and grade 6 (death). The area under the curve (AUC) was calculated by plotting the receiver operating characteristic curve (ROC) to evaluate the predictive accuracy of the MELD-Na score for the severe and mortality grades after LT. The correlation between the MELD-Na score with the complication severity grade after LT was studied by the Spearman correlation and by multivariate analysis. Results The incidences of postoperative complications for the 159 patients in this study were: grade 2 in 43 patients (27.0%, MELD-Na score 27.3±7.4), grade 3 in 41 patients (25.8%, MELD-Na score 32.7±12.4), grade 4 in 31 patients (19.5%, MELD-Na score 34.3±12.1), grade 5 in 9 patients (5.7%, MELD-Na score 30.7±12.3), grade 6 in 35 patients (22%, MELD-Na score 37.1±10.4). There was no grade 1 patient. The AUC of the MELD-Na score for the severe and death groups were 0.631 (P<0.05; 95%CI, 0.533~0.728) and 0.670 (P<0.05; 95%CI, 0.574~0.766) respectively. The MELD-Na score was significantly correlated with the Accordion severity grade (rho 0.297, P<0.01) on Spearman correlation analysis. Multivariate analysis showed that a MELD-Na score ≥25 was a risk factor of postoperative severe grade complication (P<0.05, OR=4.35), a MELD-Na score ≥35 was a risk factor of postoperative mortality (P<0.01, HR=4.72). Conclusion The MELD-Na score was significantly correlated with the Accordion severity grade, which efficaciously predicted the complication severity grades after liver transplantation. Key words: MELD-Na score; Severe hepatitis; Liver transplantation; Accordion severity grading system; Complication