Ferraz-Neto B-H, Hidalgo R, Thomé T, Melo V A, Lobue A, Zurstrassen M P V C, Moraes J M, Meira-Filho S P, Rezende M B, Fonseca L E P, Pandullo F L, Soeiro F S, Afonso R C
Figado HIAE, Albert Einstein Jewish Hospital, Av. Albert Einstein 627/701, 05652-900 São Paulo/SP, Brazil.
Transplant Proc. 2007 Oct;39(8):2511-3. doi: 10.1016/j.transproceed.2007.07.023.
The Model for End-Stage Liver Disease (MELD) was introduced in 1999 to quantify the 3-month prognosis of cirrhotic patients after a transjugular intrahepatic portosystemic shunt (TIPS). Because of the imbalance between organ donors and patients on the waiting list, the MELD was adopted by the United States in 2002 to allocate liver grafts for transplantation. Preliminary results have indicated a reduction in waiting list deaths and an increase in transplantation rates for candidates. Seeking to find a new model to predict death on the waiting list and after liver transplantation, retrospective studies have examined MELD scores in waiting list patients. The aim of this study was to analyze the MELD scores of patients on the liver waiting list for comparisons between transplanted patients.
A retrospective study was performed analyzing 131 registrations of 127 orthotopic liver transplant (OLT) patients (4 underwent retransplantation) grafted between November 2000 and January 2006, excluding 24 patients: 2 had urgent retransplantations due to hepatic artery thrombosis and 22 had incomplete data. These patients were divided into 3 groups: group I (transplanted patients)-53 patients underwent 55 OLT; group II-29 patients who died on the waiting list; group III-patients on the waiting list including 23 patients still waiting as of the date of the study.
The main indication for OLT was hepatitis C virus cirrhosis (50.50%), followed by alcoholic liver cirrhosis (23.30%), cryptogenic cirrhosis (12.60%), autoimmune hepatitis (5.80%), hepatitis B virus cirrhosis (4.85%), and primary biliary cirrhosis (2.91%). Group I: MELD score 15.62 (range, 6-39) on admission to the list, and 18.87 (range, 7-39) at transplantation. The mean waiting time for OLT was 478.39 days (range, 2-1270 days). The 38 patients who survived underwent 39 OLT (1 retransplantation). The MELD score at entrance to the list was 14.62 (range, 7-30) and at transplantation, 17.70 (range, 7-39). The mean time between admission to the list and transplantation was 505.37 days (range, 6-1270 days). The 15 patients who died had received 16 OLT (1 retransplantation). Their MELD scores were 17.80 (range, 6-39) and 21.81 (range, 9-39) at admission to the list and at transplantation, respectively, with a mean time on the waiting list of 417.93 days (range, 2-872 days). Group II: 29 patients died before OLT, at a mean age of 52.60 years (range, 22-67 years). Their MELD score was 19.24 (range, 7-45), and the interval between admission to the waiting list and death was 249.55 days (range, 3-1247 days). Group III: 23 patients still active on the OLT waiting list at the time of study displayed a mean MELD score of 13.65 (range, 6-28) and 354.30 days (range, 2-905 days) waiting until the moment. In conclusion, MELD score at the time of admission to the waiting list was higher among those patients who died either awaiting a liver graft (19.24) or after OLT (17.80) compared with those who survived after OLT (14.60) or are still awaiting OLT (13.65).
终末期肝病模型（MELD）于1999年推出，用于量化经颈静脉肝内门体分流术（TIPS）后肝硬化患者的3个月预后。由于器官捐献者与等待名单上的患者之间存在不平衡，美国于2002年采用MELD来分配肝移植供体。初步结果表明，等待名单上的死亡人数减少，候选者的移植率增加。为了寻找一种新的模型来预测等待名单上以及肝移植后的死亡情况，回顾性研究对等待名单上患者的MELD评分进行了检查。本研究的目的是分析肝移植等待名单上患者的MELD评分，以便对移植患者进行比较。
进行了一项回顾性研究，分析了2000年11月至2006年1月间接受移植的127例原位肝移植（OLT）患者（4例接受再次移植）的131次登记情况，排除24例患者：2例因肝动脉血栓形成接受紧急再次移植，22例数据不完整。这些患者被分为3组：第一组（移植患者）——53例患者接受了55次OLT；第二组——29例在等待名单上死亡的患者；第三组——等待名单上的患者，包括截至研究日期仍在等待的23例患者。
OLT的主要指征是丙型肝炎病毒肝硬化（50.50%），其次是酒精性肝硬化（23.30%）、隐源性肝硬化（12.60%）、自身免疫性肝炎（5.80%）、乙型肝炎病毒肝硬化（4.85%）和原发性胆汁性肝硬化（2.91%）。第一组：列入名单时的MELD评分为15.62（范围6 - 39），移植时为18.87（范围7 - 39）。OLT的平均等待时间为478.39天（范围2 - 1270天）。存活的38例患者接受了39次OLT（1例再次移植）。列入名单时的MELD评分为14.62（范围7 - 30），移植时为17.70（范围7 - 39）。列入名单至移植的平均时间为505.37天（范围6 - 1270天）。死亡的15例患者接受了16次OLT（1例再次移植）。他们列入名单时和移植时的MELD评分分别为17.80（范围6 - 39）和21.81（范围9 - 39），等待名单上的平均时间为417.93天（范围2 - 872天）。第二组：29例患者在OLT前死亡，平均年龄52.60岁（范围22 - 67岁）。他们的MELD评分为19.24（范围7 - 45），列入等待名单至死亡的间隔时间为249.55天（范围3 - 1247天）。第三组：在研究时仍活跃在OLT等待名单上的23例患者，MELD评分平均为13.65（范围6 - 28），等待时间为354.30天（范围2 - 905天）。总之，与OLT后存活（14.60）或仍在等待OLT（13.65）的患者相比，在等待肝移植期间死亡（19.24）或OLT后死亡（17.80）的患者，列入等待名单时的MELD评分更高。
