Abstract
Background
Consideration of the prognosis of patients with liver cirrhosis is important when determining the appropriate timing of liver transplantation. Especially in Japan, where 99% of liver transplants are from living donors, timing is very important not only for the patient but also for the family, who need time to consider the various factors involved in living donations.
Methods
To clarify the applicability of the Model for End-Stage Liver Disease (MELD) score in Japanese patients with cirrhosis, changes in the MELD score over 24 months were reviewed in 79 patients with cirrhosis who subsequently died of liver failure (n = 33) or who survived 24 months (n = 46). All patients had Child class B or C cirrhosis at the start of follow-up. We also compared their survival with that of 30 patients treated by living donor liver transplantation (LDLT) in our institute to determine the proper timing of transplantation in patients with cirrhosis.
Results
Significant stratification of survival curves was observed for MELD scores of <12, 12–15, 15–18, and >18 (P = 0.0018). A significant survival benefit of LDLT was observed in patients with MELD score ≥15 (P = 0.0181), and significantly more risk with transplantation was observed in those with MELD score <15 compared with that of patients in whom the disease followed its natural course (P = 0.0168).
Conclusions
MELD score is useful for predicting 1-year survival in Japanese patients with cirrhosis. MELD scores of 15 had discriminatory value for indicating a survival benefit to be gained by liver transplantation and thus can be used to help patients and their families by identifying patients who would benefit from LDLT.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Arroyo V, Gines A, Salo J. A European survey on the treatment of ascites in cirrhosis. J Hepatol 1994;21:667–672.
Lucena MI, Andrade RJ, Tognoni G, Hidalgo R, De La Cuesta FS. Multicenter hospital study on prescribing patterns for prophylaxis and treatment of complications of cirrhosis. Eur J Clin Pharmacol 2002;58:435–440.
Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology 1998;27:264–272.
Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. N Engl J Med 1988;319:983–989.
Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001;33:802–807.
Pagliaro L, D’Amico G, Sorensen TI, Lebrec D, Burroughs AK, Morabito A, et al. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med 1992;117:59–70.
Sheer TA, Runyon BA. Spontaneous bacterial peritonitis. Dig Dis 2005;23:39–46.
Planas R, Balleste B, Alvarez MA, Rivera M, Montoliu S, Galeras JA, et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol 2004;40:823–830.
Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993;18:353–358.
Garcia-Tsao G. Spontaneous bacterial peritonitis. Gastroenterol Clin North Am 1992;21:257–275.
Novella M, Sola R, Soriano G, Andreu M, Gana J, Ortiz J, et al. Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology 1997;25:532–536.
Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000;32:142–153.
Sandhu BS, Gupta R, Sharma J, Singh J, Murthy NS, Sarin SK. Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites. J Gastroenterol Hepatol 2005;20:599–605.
Toledo C, Salmeron JM, Rimola A, Navasa M, Arroyo V, Llach J, et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology 1993;17:251–257.
Chalasani N, Horlander JC Sr, Said A, Hoen H, Kopecky KK, Stockberger SM Jr, et al. Screening for hepatocellular carcinoma in patients with advanced cirrhosis. Am J Gastroenterol 1999;94:2988–2993.
Dahlke MH, Popp FC, Eggert N, Hoy L, Tanaka H, Sasaki K, et al. Differences in attitude toward living and postmortal liver donation in the United States, Germany, and Japan. Psychosomatics 2005;46:58–64.
Kiuchi T, Tanaka K. Liver transplantation from living donors: current status in Japan and safety/long-term results in the donor. Transplant Proc 2003;35:1172–1173.
Shimada M, Fujii M, Morine Y, Imura S, Ikemoto T, Ishibashi H. Living-donor liver transplantation: present status and future perspective. J Med Invest 2005;52:22–32.
Tanaka K, Yamada T. Living donor liver transplantation in Japan and Kyoto University: what can we learn? J Hepatol 2005;42:25–28.
Todo S, Furukawa H, Jin MB, Shimamura T. Living donor liver transplantation in adults: outcome in Japan. Liver Transpl 2000;6:S66–S72.
Adam R, McMaster P, O’Grady JG, Castaing D, Klempnauer JL, Jamieson N, et al. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003;9:1231–1243.
Bak T, Wachs M, Trotter J, Everson G, Trouillot T, Kugelmas M, et al. Adult-to-adult living donor liver transplantation using rightlobe grafts: results and lessons learned from a single-center experience. Liver Transpl 2001;7:680–686.
Boillot O, Belghiti J, Azoulay D, Gugenheim J, Soubrane O, Cherqui D. Initial French experience in adult-to-adult living donor liver transplantation. Transplant Proc 2003;35:962–963.
Broelsch CE, Malago M, Testa G, Valentin Gamazo C. Living donor liver transplantation in adults: outcome in Europe. Liver Transpl 2000;6:S64–S65.
Brown RS Jr, Russo MW, Lai M, Shiffman ML, Richardson MC, Everhart JE, et al. A survey of liver transplantation from living adult donors in the United States. N Engl J Med 2003;348:818–825.
Chen CL, Fan ST, Lee SG, Makuuchi M, Tanaka K. Living-donor liver transplantation: 12 years of experience in Asia. Transplantation 2003;75:S6–S11.
Malago M, Testa G, Frilling A, Nadalin S, Valentin-Gamazo C, Paul A, et al. Right living donor liver transplantation: an option for adult patients: single institution experience with 74 patients. Ann Surg 2003;238:853–862; discussion 862–3.
Sugawara Y, Makuuchi M. Advances in adult living donor liver transplantation: a review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in Tokyo. Liver Transpl 2004;10:715–720.
Adam R, Lucidi V, Karam V. Liver transplantation in Europe: is there a room for improvement? J Hepatol 2005;42:33–40.
Bilbao I, Figueras J, Grande L, Cleries M, Jaurrieta E, Visa J, et al. Risk factors for death following liver retransplantation. Transplant Proc 2003;35:1871–1873.
Hunt CM, Camargo CA Jr, Dominitz JA, Bute BP, Clavien PM. Effect of postoperative complications on health and employment following liver transplantation. Clin Transplant 1998;12:99–103.
Lee SG, Park KM, Lee YJ, Hwang S, Choi DR, Ahn CS, et al. 157 adult-to-adult living donor liver transplantation. Transplant Proc 2001;33:1323–1325.
Lo CM, Fan ST, Liu CL, Yong BH, Wong Y, Lau GK, et al. Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg 2004;240:151–158.
Matinlauri IH, Nurminen MM, Hockerstedt KA, Isoniemi HM. Risk factors predicting survival of liver transplantation. Transplant Proc 2005;37:1155–1160.
Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, et al. The survival benefit of liver transplantation. Am J Transplant 2005;5:307–313.
Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL consortium. Ann Surg 2005;242:314–325.
Settmacher U, Theruvath T, Pascher A, Neuhaus P. Living-donor liver transplantation—European experiences. Nephrol Dial Transplant 2004;19Suppl 4:iv16–iv21.
Smith CM, Davies DB, McBride MA. Liver transplantation in the United States: a report from the Organ Procurement and Transplantation Network. Clin Transpl 2000;19–30.
Testa G, Malago M, Valentin-Gamazo C, Lindell G, Broelsch CE. Biliary anastomosis in living related liver transplantation using the right liver lobe: techniques and complications. Liver Transpl 2000;6:710–714.
Thuluvath PJ, Yoo HY, Thompson RE. A model to predict survival at one month, one year, and five years after liver transplantation based on pretransplant clinical characteristics. Liver Transpl 2003;9:527–532.
Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med 2002;346:1074–1082.
Heuman DM, Mihas A. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology 2003;125:992–993; author reply 994–5.
Surman OS. The ethics of partial-liver donation. N Engl J Med 2002;346:1038.
Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K, et al. Operative morbidity of living liver donors in Japan. Lancet 2003;362:687–690.
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–470.
Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlich J, et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut 2003;52:879–885.
Boin IF, Leonardi MI, Pinto AO, Leme RS, Udo E, Stucchi RS, et al. Liver transplant recipients mortality on the waiting list: long-term comparison to Child-Pugh classification and MELD. Transplant Proc 2004;36:920–922.
Botta F, Giannini E, Romagnoli P, Fasoli A, Malfatti F, Chiarbonello B, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003;52:134–139.
Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding. Hepatology 2002;35:1282–1284.
Dunn W, Jamil LH, Brown LS, Wiesner RH, Kim WR, Menon KV, et al. MELD accurately predicts mortality in patients with alcoholic hepatitis. Hepatology 2005;41:353–358.
Giannini E, Botta F, Testa R. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology 2003;125:993–994; author reply 994–5.
Russo MW, Brown RS, Jr. Adult living donor liver transplantation. Am J Transplant 2004;4:458–465.
Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application of survival models to liver allocation. Liver Transpl 2001;7:567–580.
Papatheodoridis GV, Cholongitas E, Dimitriadou E, Touloumi G, Sevastianos V, et al. MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis. World J Gastroenterol 2005;11:3099–3104.
Salerno F, Merli M, Cazzaniga M, Valeriano V, Rossi P, Lovaria A, et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 2002;36:494–500.
Gheorghe L, Popescu I, Iacob R, Iacob S, Gheorghe C. Predictors of death on the waiting list for liver transplantation characterized by a long waiting time. Transpl Int 2005;18:572–576.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ishigami, M., Honda, T., Okumura, A. et al. Use of the Model for End-Stage Liver Disease (MELD) score to predict 1-year survival of Japanese patients with cirrhosis and to determine who will benefit from living donor liver transplantation. J Gastroenterol 43, 363–368 (2008). https://doi.org/10.1007/s00535-008-2168-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-008-2168-7