To improve the outcome of living donor liver transplantation (LDLT), a scoring system that could predict accurately the patient and graft survival posttransplant is necessary. The aim of this study is to evaluate our previously proposed Muscle-model for end-stage liver disease (M-MELD) score and to compare it with the other available scores to find the best system that correlates with postoperative outcome after liver transplant.
Methods:
We retrospectively reviewed the data of 199 patients who underwent LDLT from January 2010 to July 2016 and calculated the preoperative MELD, MELD Na, the product of donor age and MELD (D-MELD), M-MELD, integrated MELD, and the balance of risk (BAR) score in all patients. The area under the receiver operating characteristics curves (AUCs) of each score was computed and compared at 3-, 6-months, and 1-year after LDLT.
Results:
The M-MELD, D-MELD, and integrated MELD had a good discriminative performance in predicting 3-month mortality after LDLT with AUCs > 0.7, while the M-MELD was the only score that showed a good discriminative performance in predicting 6-month and 1-year mortality after LDLT with AUCs > 0.7.
Conclusion:
Muscle-MELD score is a simple and useful predictor of patient survival after LDLT which showed a better predictive performance than other available scores.
KaidoTEgawaHTsujiHAshiharaEMaekawaTUemotoS. In-hospital mortality in adult recipients of living donor liver transplantation: experience of 576 consecutive cases at a single center. Liver Transpl. 2009;15(11):1420–1425. doi:10.1002/lt.21873
2.
KleinKBStafinskiTDMenonD. Predicting survival after liver transplantation based on pre-transplant MELD score: a systematic review of the literature. PLoS One. 2013;8(12):e80661. doi:10.1371/journal.pone.0080661
3.
DutkowskiPOberkoflerCESlankamenacK. Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era. Ann Surg. 2011;254(5):745–753. doi:10.1097/SLA.0b013e3182365081
4.
KimWRBigginsSWKremersWK. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–1026. doi:10.1056/NEJMoa0801209
5.
LeeHYoonSOhSY. Comparison of APACHE IV with APACHE II, SAPS 3, MELD, MELD-Na, and CTP scores in predicting mortality after liver transplantation. Sci Rep. 2017;7(1):10884. doi:10.1038/s.41598-017-07797-2
6.
El AmirMGamal EldeenHMogawerS. Different score systems to predict mortality in living donor liver transplantation: which is the winner? The experience of an egyptian center for living donor liver transplantation. Transplant Proc. 2015;47(10):2897–2901. doi:10.1016/j.transproceed.2015.10.022
7.
HalldorsonJBBakthavatsalamRFixOReyesJDPerkinsJD. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. Am J Transplant. 2009;9(2):318–326. doi:10.1111/j.1600-6143.2008.02491.x
8.
Cepeda-FrancoCBernal-BellidoCBarrera-PulidoL. Survival outcomes in liver transplantation with elderly donors: analysis of andalusian transplant register. Transplant Proc. 2016;48(9):2983–2986. doi:10.1016/j.transproceed.2016.09.026
9.
HamaguchiYKaidoTOkumuraS. Proposal of muscle-MELD score, including muscularity, for prediction of mortality after living donor liver transplantation. Transplantation. 2016;100(11):2416–2423.
10.
UemuraTWadaSKaidoT. How far can we lower graft-to-recipient weight ratio for living donor liver transplantation under modulation of portal venous pressure?Surgery. 2016;159(6):1623–1630. doi:10.1016/j.surg.2016.01.099
11.
BadawyAHamaguchiYSeoSKaidoTOkajimaHUemotoS. Evaluation of safety of concomitant splenectomy in living donor liver transplantation: a retrospective study. Transpl Int. 2017;30(9):914–923. doi:10.1111/tri.12985
12.
SingalAKKamathPS. Model for end-stage liver disease. J Clin Exp Hepatol. 2013;3(1):50–60. doi:10.1016/j.jceh.2012.11.002
HanleyJAMcNeilBJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.
15.
KimHJLarsonJJLimYS. Impact of MELD on waitlist outcome of retransplant candidates. Am J Transplant. 2010;10(12):2652–2657. doi:10.1111/j.1600-6143.2010.03315.x
16.
QuanteMBenckertCThelenAJonasS. Experience since MELD implementation: how does the new system deliver?Int J Hepatol. 2012;2012:264015. doi:10.1155/2012/264015
17.
WeismüllerTJFikatasPSchmidtJ. Multicentric evaluation of model for end-stage liver disease-based allocation and survival after liver transplantation in Germany–limitations of the ‘sickest first’-concept. Transpl Int. 2011;24(1):91–99. doi:10.1111/j.1432-2277.2010.01161.x
18.
BrunsHHillebrandNSchneiderT. LabMELD-based organ allocation increases total costs of liver transplantation: a single-center experience. Clin Transplant. 2011;25(5): E558–E565. doi:10.1111/j.1399-0012.2011.01483.x
19.
CywinskiJBMaschaEJYouJ. Pre-transplant MELD and sodium MELD scores are poor predictors of graft failure and mortality after liver transplantation. Hepatol Int. 2011;5(3):841–849. doi:10.1007/s12072-011-9257-z
20.
LucaAAngermayrBBertoliniG. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl. 2007;13(8):1174–1180
21.
ChungISParkMKoJSGwakMSKimGSLeeSK. Which score system can best predict recipient outcomes after living donor liver transplantation?Transplant Proc. 2012;44(2):393–395. doi:10.1016/j.transproceed.2012.01.064
22.
IkegamiTImaiDWangH. D-MELD as a predictor of early graft mortality in adult-to-adult living-donor liver transplantation. Transplantation. 2014;97(4):457–462. doi:10.1097/01.TP.0000435696.23525.d0
23.
MaYWangQYangJYanL. Comparison of different scoring systems based on both donor and recipient characteristics for predicting outcome after living donor liver transplantation. PLoS One. 2015;10(9):e0136604. doi:10.1371/journal.pone.0136604
24.
KaidoTOgawaKFujimotoY. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transplant. 2013;13(6):1549–1556. doi:10.1111/ajt.12221
25.
KaidoTTamaiYHamaguchiY. Effects of pretransplant sarcopenia and sequential changes in sarcopenic parameters after living donor liver transplantation. Nutrition. 2017;33:195–198. doi:10.1016/j.nut.2016.07.002
26.
KalafateliMMantzoukisKChoi YauY. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the model for end-stage Liver Disease score. J Cachexia Sarcopenia Muscle. 2017;8(1):113–121. doi:10.1002/jcsm.12095
27.
IzumiTWatanabeJTohyamaTTakadaY. Impact of psoas muscle index on short-term outcome after living donor liver transplantation. Turk J Gastroenterol. 2016;27(4):382–388. doi:10.5152/tjg.2016.16201
28.
JeonJYWangHJOckSY. Newly developed sarcopenia as a prognostic factor for survival in patients who underwent liver transplantation. PLoS One. 2015;10(11):e0143966. doi:10.1371/journal.pone.0143966
29.
Montano LozaAJMeza JuncoJPradoCM. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166–173. doi:10.1016/j.cgh.2011.08.028
30.
Montano-LozaAJDuarte-RojoAMeza-JuncoJ. Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis. Clin Transl Gastroenterol. 2015;6:e102. doi:10.1038/ctg.2015.31
31.
HamaguchiYKaidoTOkumuraS. Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation. Liver Transpl. 2014;20(11):1413–1419. doi:10.1002/lt.23970
