Multi-Organ Transplant Program, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Transpl Int. 2011 Mar;24(3):292-9. doi: 10.1111/j.1432-2277.2010.01200.x. Epub 2010 Dec 10.
MELD score has been used to predict 90-day mortality of subjects listed for liver transplantation (OLT). Validation of MELD score for patients on the waiting list in transplant programmes serving rural areas in North America is lacking. A retrospective cohort of patients affected by end-stage liver disease was studied to assess the mortality rate within 90 days after being listed at our transplant centre. Secondary aims were to identify differences between predicted and observed 90-days mortality using MELD and MELDNa scores at the time of listing. Among 126 patients included in this study, waiting list mortality was 35.0%. Ninety-day mortality was 21.1%, which was significantly greater than the mortality estimated by the MELD (9.1%, 95% CI: 6.6-11.5) and MELDNa (9.3%, 95%CI: 6.0-12.5). Despite this underestimation, AUC for MELD and MELDNa was 0.80 and 0.78 respectively. In our study, independent predictors of waiting list mortality were age, diagnosis of cholestatic disease and residence over 500 km from our transplant centre. MELD and MELDNa underestimated the 90-day mortality in patients with liver failure living in rural areas. Validation of these models should be performed in other transplant centres serving patients with limited access to specialized services.
MELD 评分被用于预测接受肝移植（OLT）的患者 90 天死亡率。然而，对于在北美农村地区的移植项目中等待名单上的患者，MELD 评分的验证是缺乏的。本研究回顾性分析了一组终末期肝病患者，以评估我们移植中心登记后 90 天内的死亡率。次要目的是在登记时使用 MELD 和 MELDNa 评分，确定预测与观察到的 90 天死亡率之间的差异。在这项研究中，纳入的 126 名患者中，等待名单死亡率为 35.0%。90 天死亡率为 21.1%，显著高于 MELD（9.1%，95%CI：6.6-11.5）和 MELDNa（9.3%，95%CI：6.0-12.5）的估计死亡率。尽管存在低估，MELD 和 MELDNa 的 AUC 分别为 0.80 和 0.78。在我们的研究中，等待名单死亡率的独立预测因素是年龄、胆汁淤积性疾病的诊断和距离我们移植中心 500 公里以上的居住地。在居住在农村地区的肝功能衰竭患者中，MELD 和 MELDNa 低估了 90 天死亡率。这些模型的验证应在为获得专业服务有限的患者提供服务的其他移植中心进行。
