Brandão Ajacio, Fuchs Sandra C, Gleisner Ana L, Marroni C, Zanotelli Maria L, Cantisani Guido
Liver Transplantation Group, Complexo Hospitalar Santa Casa, Porto Alegre-RS, Brazil.
Clin Transplant. 2009 Mar-Apr;23(2):220-7. doi: 10.1111/j.1399-0012.2008.00943.x. Epub 2009 Feb 5.
This study examined how reliable is the pre-transplant model for end-stage liver disease (MELD) score in predicting post-transplantation survival and analyzed variables associated with patient survival.
A cohort study was conducted. Receiver operating characteristic curve c-statistics were used to determine the ability of MELD score to predict mortality. The Kaplan-Meier (KM) method was used to analyze survival as a function of time regarding the MELD score and Child-Turcotte-Pugh (CTP) category. The Cox model was employed to assess the association between baseline risk factors and mortality.
Recipients and donors were mostly male, with a mean age of 51.6 and 38.5 yr, respectively (n = 436 transplants). The c-statistic values for three-month patient mortality were 0.60 and 0.61 for MELD score and CTP category, respectively. KM survival at three, six and 12 months were lower in those who had a MELD score > or =21 or were CTP category C. Multivariate analysis revealed that recipient age > or =65 yr, MELD > or = 21, CTP C category, bilirubin > or = 7 mg/dL, creatinine > or = 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non-white color donor skin were predictors of mortality.
Severe pre-transplant liver disease, age > or = 65, non-white skin donor, and hepatocellular carcinoma are associated with poor outcome.
本研究探讨了终末期肝病模型（MELD）评分在预测肝移植术后生存率方面的可靠性，并分析了与患者生存相关的变量。
进行了一项队列研究。采用受试者工作特征曲线c统计量来确定MELD评分预测死亡率的能力。采用Kaplan-Meier（KM）方法分析MELD评分和Child-Turcotte-Pugh（CTP）分级随时间变化的生存情况。采用Cox模型评估基线危险因素与死亡率之间的关联。
受者和供者大多为男性，平均年龄分别为51.6岁和38.5岁（n = 436例移植）。MELD评分和CTP分级预测三个月患者死亡率的c统计量值分别为0.60和0.61。MELD评分≥21或CTP分级为C级的患者在3个月、6个月和12个月时的KM生存率较低。多因素分析显示，受者年龄≥65岁、MELD≥21、CTP C级、胆红素≥7mg/dL、肌酐≥1.5mg/dL、血小板输注、肝细胞癌和非白人供者皮肤是死亡率的预测因素。
移植前严重肝病、年龄≥65岁、非白人皮肤供者和肝细胞癌与不良预后相关。
