Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Authors

  • Robert S. Brown Jr MD, MPH,

    Corresponding author
    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
    2. Columbia University College of Physicians and Surgeons
    • Center for Liver Disease & Transplantation, Columbia Presbyterian Medical Center, 622 West 168th Street, PH 14, New York, NY 10036. Telephone: 212-305-0662; FAX: 212-305-9139
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  • K. Shiva Kumar,

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
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  • Mark W. Russo,

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
    2. Columbia University College of Physicians and Surgeons
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  • Milan Kinkhabwala,

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
    2. Weill Medical College of Cornell University, New York, NY
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  • Dianne L. Rudow,

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
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  • Patricia Harren,

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
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  • Steven Lobritto,

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
    2. Columbia University College of Physicians and Surgeons
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  • Jean C. Emond

    1. Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, NY
    2. Columbia University College of Physicians and Surgeons
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Abstract

The Model for End-Stage Liver Disease (MELD) has been proposed as a replacement for the Child-Turcotte-Pugh (CTP) classification to stratify patients for prioritization for orthotopic liver transplantation (OLT). Improved classification of patients with decompensated cirrhosis might allow timely OLT before the development of life-threatening complications, reducing the number of critically ill patients listed as United Network for Organ Sharing (UNOS) status 2A at the time of OLT. We compared the ability of the MELD and CTP scores to predict pre-OLT disease severity, as well as outcome and resource utilization post-OLT. Data from 42 consecutive UNOS status 2A patients undergoing OLT at a single center were used to calculate MELD and CTP scores at the time of status 2A listing. Multivariate analysis was used to determine the relationship between these scores and pre-OLT disease severity measures, survival post-OLT, and measures of resource use post-OLT. The MELD was superior to CTP score in predicting pre-OLT requirements for mechanical ventilation and dialysis. Neither score correlated with the resource utilization parameters studied. Only two patients died within 3 months post-OLT; neither score was predictive of survival in this cohort. In summary, the MELD is superior to CTP score in estimating pre-OLT disease severity in UNOS status 2A patients and thus may help risk stratify status 2A or decompensated status 2B OLT candidates and optimize the timing of OLT. However, neither score correlated with resource use post-OLT in the strata of critically ill patients.

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