Habib Shahid, Berk Brian, Chang Chung-Chou H, Demetris Anthony J, Fontes Paulo, Dvorchik Igor, Eghtesad Bijan, Marcos Amadeo, Shakil A Obaid
Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Liver Transpl. 2006 Mar;12(3):440-7. doi: 10.1002/lt.20721.
The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. It has since become the standard tool to prioritize patients for liver transplantation. We assessed the value of pretransplant MELD in the prediction of posttransplant survival. We identified adult patients who underwent liver transplantation at our institution during 1991-2002. Among 2,009 recipients, 1,472 met the inclusion criteria. Based on pretransplant MELD scores, recipients were stratified as low risk (< or = 15), medium risk (16-25), and high risk (>25). The primary endpoints were patient and graft survival. Mean posttransplant follow-up was 5.5 years. One-, 5- and 10-year patient survival was 83%, 72%, and 58%, respectively, and graft survival was 76%, 65%, and 53%, respectively. In univariable analysis, patient and donor age, patient sex, MELD score, disease etiology, and retransplantation were associated with posttransplantation patient and graft survival. In multivariable analysis adjusted for year of transplantation, patient age >65 years, donor age >50 years, male sex, and retransplantation and pretransplant MELD scores >25 were associated with poor patient and graft survival. The impact of MELD score >25 was maximal during the first year posttransplant. In conclusion, older patient and donor age, male sex of recipient, retransplantation, and high pretransplant MELD score are associated with poor posttransplant outcome. Pretransplant MELD scores correlate inversely with posttransplant survival. However, better prognostic models are needed that would provide an overall assessment of transplant benefit relative to the severity of hepatic dysfunction.
终末期肝病模型（MELD）旨在预测肝硬化患者的短期死亡率。自那时起，它已成为将患者列入肝移植优先名单的标准工具。我们评估了移植前MELD在预测移植后生存率方面的价值。我们确定了1991年至2002年期间在我们机构接受肝移植的成年患者。在2009名受者中，1472名符合纳入标准。根据移植前MELD评分，受者被分为低风险（≤15）、中风险（16 - 25）和高风险（>25）。主要终点是患者和移植物生存率。移植后的平均随访时间为5.5年。1年、5年和10年的患者生存率分别为83%、72%和58%，移植物生存率分别为76%、65%和53%。在单变量分析中，患者和供体年龄、患者性别、MELD评分、疾病病因和再次移植与移植后患者和移植物生存率相关。在对移植年份进行调整的多变量分析中，患者年龄>65岁、供体年龄>50岁、男性性别、再次移植以及移植前MELD评分>25与患者和移植物生存率差相关。MELD评分>25的影响在移植后的第一年最大。总之，患者和供体年龄较大、受者为男性、再次移植以及移植前MELD评分高与移植后不良结局相关。移植前MELD评分与移植后生存率呈负相关。然而，需要更好的预后模型，以根据肝功能障碍的严重程度对移植益处进行全面评估。
