Predicting short-term survival after liver transplantation on eight score systems: a national report from China Liver Transplant Registry.
Predicting short-term survival after liver transplantation on eight score systems: a national report from China Liver Transplant Registry.
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DOI：
10.1038/srep42253
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发表时间：
2017-02-13
影响因子：
4.6
通讯作者：
Zheng S
中科院分区：
文献类型：
--
作者：
Ling Q;Dai H;Zhuang R;Shen T;Wang W;Xu X;Zheng S
比较8种评分系统(MELD、uMELD、MELD-Na)的性能。在预测移植后死亡率方面，我们分析了中国肝脏移植登记数据库中2003年1月至2010年12月间6,014例成年肝硬变患者的肝移植数据。在乙肝病毒感染组中，MELD、uMELD和MELD-AS对肝移植后3个月死亡率的预测准确率较高，与其他5个模型相比，MELD对3个月、6个月和1年死亡率的预测能力最强，其预测能力明显优于UKELD和iMELD。在丙型肝炎病毒和酒精组中，MELD和其他模型之间的预测能力没有显著差异。不同MELD类别的患者存活率差异有统计学意义。在MELD评分为35分的患者中，一种基于血肌酐、需要血液透析和中度腹水的新预后模型可以确定病情最严重的患者。综上所述，MELD在预测乙肝相关性肝病患者移植后短期存活率方面优于其他评分系统。在MELD评分为35分的患者中，一种新的预后模型可以识别哪些患者病情最重，应该被排除在等待名单之外，以防止浪费的移植。
To compare the performance of eight score systems (MELD, uMELD, MELD-Na. iMELD, UKELD, MELD-AS, CTP, and mCTP) in predicting the post-transplant mortality, we analyzed the data of 6,014 adult cirrhotic patients who underwent liver transplantation between January 2003 and December 2010 from the China Liver Transplant Registry database. In hepatitis B virus (HBV) group, MELD, uMELD and MELD-AS showed good predictive accuracies at 3-month mortality after liver transplantation; by comparison with other five models, MELD presented the best ability in predicting 3-month, 6-month and 1-year mortality, showing a significantly better predictive ability than UKELD and iMELD. In hepatitis C virus and Alcohol groups, the predictive ability did not differ significantly between MELD and other models. Patient survivals in different MELD categories were of statistically significant difference. Among patients with MELD score >35, a new prognostic model based on serum creatinine, need for hemodialysis and moderate ascites could identify the sickest one. In conclusion, MELD is superior to other score systems in predicting short-term post-transplant survival in patients with HBV-related liver disease. Among patients with MELD score >35, a new prognostic model can identify the sickest patients who should be excluded from waiting list to prevent wasteful transplantation.