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KMID : 0356920100590030160
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Korean Journal of Anesthesiology
2010 Volume.59 No. 3 p.160 ~ p.166
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Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation
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Hwang Won-Jung
Park Chul-Soo
Kang Sung-Hee
Jeon Jun-Pyo
Chung Hyun-Sik
Kim Jo-Yong
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Abstract
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Background The pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality.
Methods Perioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox’s proportional hazards regression.
Results The 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P < 0.05). After multivariate analyses, declines in post-MELD scores until the 5th day of less than 5 points (hazard ratio 2.35, P = 0.007) and prolonged mechanical ventilation ≥24 hours were the earliest independent predictors of 1-year mortality.
Conclusions A sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.
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KEYWORD
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Liver transplantation, Living donor, Mortality, Prediction
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