El Amir M, Gamal Eldeen H, Mogawer S, Esmat G, El-Shazly M, El-Garem N, Abdelaziz M S, Salah A, Hosny A
Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Endemic Hepato-Gasteroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Transplant Proc. 2015 Dec;47(10):2897-901. doi: 10.1016/j.transproceed.2015.10.022.
Many scoring systems have been proposed to predict the outcome of deceased donor liver transplantation. However, their impact on the outcome in living donor liver transplantation (LDLT) has not yet been elucidated. This study sought to assess performance of preoperative Model for End-Stage Liver Disease (MELD) score in predicting postoperative mortality in LDLT and to compare it with other scores: MELDNa, United Kingdom End-Stage Liver Disease (UKELD), MELD to serum sodium ratio (MESO), updated MELD, donor age-MELD (D-MELD) and integrated MELD (iMELD).
We retrospectively analyzed data from 86 adult Egyptian patients who underwent LDLT in a single center. Preoperative MELD, MELDNa, MESO, UKELD, updated MELD, D-MELD, and iMELD were calculated. Receiver-operator characteristic (ROC) curves and area under the curve (AUC) were used to assess the performance of MELD and other scores in predicting postoperative mortality at 3 months (early) and 12 months.
Among the 86 patients, mean age 48 ± 7 years, 76 (88%) were of male sex and 27 (31.4%) had died. Preoperative MELD failed to predict early mortality (AUC = 0.63; P = .066). Comparing preoperative MELD with other scores, all other scores had better predictive ability (P < .05), with D-MELD on the top of the list (AUC = 0.68, P = .016), followed closely by UKELD (AUC = 0.67, P = .025). After that were iMELD, MESO, and MELDNa with the same predictive performance (AUC = 0.65; P < .05); updated MELD had the lowest prediction (AUC = 0.640; P = .04). Moreover, all scores failed to predict mortality at 12 months (P > .05).
Preoperative MELD failed to predict either early or 1-year mortality after LDLT. D-MELD, UKELD, MELDNa, iMELD, and MESO could be used as better predictors of early mortality than MELD; however, we need to develop an effective score system to predict mortality after LDLT.
已经提出了许多评分系统来预测尸体供肝肝移植的结果。然而，它们对活体供肝肝移植（LDLT）结果的影响尚未阐明。本研究旨在评估术前终末期肝病模型（MELD）评分在预测LDLT术后死亡率方面的性能，并将其与其他评分进行比较：MELDNa、英国终末期肝病（UKELD）、MELD与血清钠比值（MESO）、更新后的MELD、供体年龄-MELD（D-MELD）和综合MELD（iMELD）。
我们回顾性分析了在单一中心接受LDLT的86例成年埃及患者的数据。计算术前MELD、MELDNa、MESO、UKELD、更新后的MELD、D-MELD和iMELD。采用受试者操作特征（ROC）曲线和曲线下面积（AUC）来评估MELD和其他评分在预测3个月（早期）和12个月术后死亡率方面的性能。
86例患者中，平均年龄48±7岁，76例（88%）为男性，27例（31.4%）死亡。术前MELD未能预测早期死亡率（AUC = 0.63；P = 0.066）。将术前MELD与其他评分进行比较，所有其他评分具有更好的预测能力（P < 0.05），其中D-MELD位居榜首（AUC = 0.68，P = 0.016），紧随其后的是UKELD（AUC = 0.67，P = 0.025）。之后是iMELD、MESO和MELDNa，它们具有相同的预测性能（AUC = 0.65；P < 0.05）；更新后的MELD预测能力最低（AUC = 0.640；P = 0.04）。此外，所有评分均未能预测12个月时的死亡率（P > 0.05）。
术前MELD未能预测LDLT术后的早期或1年死亡率。与MELD相比，D-MELD、UKELD、MELDNa、iMELD和MESO可作为更好的早期死亡率预测指标；然而，我们需要开发一种有效的评分系统来预测LDLT后的死亡率。
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