Adler M, De Gendt E, Vereerstraeten P, Degré D, Bourgeois N, Boon N, Gelin M, Ickx B, Donckier V
Medico-Surgical Department of Gastroenterology and Anesthesiology, Hôpital Erasme, Brussels, Belgium.
Transplant Proc. 2005 Jul-Aug;37(6):2863-4. doi: 10.1016/j.transproceed.2005.05.007.
The MELD score has now been implemented in the United States for liver allocation, but it has not been validated in Europe. Its association with posttransplant outcome is unclear. Optimal cutoff values of MELD and Child-Pugh scores to predict death on the liver waiting list were defined in a series of 137 cirrhotic patients listed for liver transplantation. Six-month actuarial survival while on the waiting list was 90% with a Child-Pugh <11 and MELD <17, whereas it decreased progressively to 40% at 6 months after listing for those having a Child-Pugh and MELD score >10 and >16. Analysis of a series of 112 patients (85 chronic liver disease and 27 hepatocellular carcinoma) revealed no change in MELD value at the time of transplantation compared to the score at the time of listing (mean +/- SD: 15.5 +/- 7.7 vs 15 +/- 5.8) with a mean waiting time of 118 days. Using either the optimal cutoff for MELD score (<17 or >16) or seven different strata (3 to 7, 8 to 10, 11 to 13, 14 to 16, 17 to 19, 20 to 22, 23 to 39), whether measured at listing or just before liver transplantation, there was no significant difference (chi(2) 4.97, P = .58) in survival: 82.7% and 63% at 6 and 60 months, overall. Our data confirm that the MELD score with only three parameters is as good as the Child-Pugh score to predict mortality on the Eurotransplant waiting list. The optimal cutoff to assess higher priority for the bad category is >16. There was no negative impact on short- or long-term prognosis of the bad categories of MELD.
终末期肝病模型（MELD）评分现已在美国用于肝脏分配，但在欧洲尚未得到验证。其与移植后结局的关联尚不清楚。在一系列137例等待肝移植的肝硬化患者中确定了MELD和Child-Pugh评分预测肝脏等待名单上死亡的最佳临界值。等待名单上6个月的精算生存率在Child-Pugh评分<11且MELD评分<17时为90%，而对于Child-Pugh评分和MELD评分>10和>16的患者，在列入名单后6个月时逐渐降至40%。对一系列112例患者（85例慢性肝病和27例肝细胞癌）的分析显示，移植时的MELD值与列入名单时的评分相比无变化（平均值±标准差：15.5±7.7 vs 15±5.8），平均等待时间为118天。使用MELD评分的最佳临界值（<17或>16）或七个不同分层（3至7、8至10、11至13、14至16、17至19、20至22、23至39），无论在列入名单时还是在肝移植前测量，生存率均无显著差异（χ² 4.97，P = 0.58）：6个月和60个月时总体生存率分别为82.7%和63%。我们的数据证实，仅包含三个参数的MELD评分在预测欧洲移植等待名单上的死亡率方面与Child-Pugh评分一样好。评估不良类别更高优先级的最佳临界值>16。MELD不良类别对短期或长期预后没有负面影响。
