Impact of pretransplant MELD score on posttransplant outcome in orthotopic liver transplantation for patients with acute-on-chronic hepatitis B liver failure

Objective To evaluate the usefulness of the model for end-stage liver disease(MELD)score in comparison with the Child-Turcotte-Pugh(CTP)score to predict postoperative short-term survival and 3-month morbidity in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation. Methods Data of all patients undergoing orthotopic liver transplantation in our unit;from December 1999 to November 2005,were analyzed retrospectively.MELD and CTP scores were calculated for each patient according to the original formula on the admission day.MELD and CTP accuracy in predicting postoperative short-term survival and 3-month morbidity was assessed using receiver operating characteristic(ROC)analysis and Kaplan-Meier analysis respectively.Resuiis Seven out of 42 patients died within 3-month follow-up.MELD scores in non survivors(32.97±7.11)were higher than those in survivors(24.90±4.96)significantly(P＜0.01),and CTP scores were significantly highter too(12.57±0.98 vs. 11.51±1.17,P＜0.05).ROC analysis identified that the MELD best cutoff point was 25.67 in predicting postoperative morbidity(area under the curve[AUC]=0.841;sensitivity=85.7 %;specificity=60.0 %),and the CTP best cutoff point was 11.5(AUC=0.747;sensitivity=85.7 %;specificity=54.3 %).MELD score was a better method than CTP score for predicting the postoperative short-term survival and 3 month morbidity in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation.Conclusion MELD score was an objective predictive system and was more efficient than CTP score in evaluating the risk of 3-month morbidity and short-term prognosis in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation. Key words: Hepatitis B,chronic; Liver transplantation; Prognosis