Clinical–Liver, Pancreas, and Biliary TractModel for end-stage liver disease (MELD) and allocation of donor livers☆,☆☆
Section snippets
Patient population
The cohort of patients used for this analysis included adults (≥18 years of age) with chronic liver disease who were added to OPTN liver waiting list at a 2A or 2B status between November, 1999, and December, 2001. Of the 6651 adult patients with chronic liver disease who were listed during this time period, 3437 (52%) had complete MELD data at the time of listing, including serum creatinine, serum bilirubin, and INR. Because prothrombin time rather than INR was often reported for patients at
Results
The mean age of the study cohort was 50.7 years (range, 18–79 years), and two thirds of the patients were men (Table 2).Age (yr), mean (range) 50.7 (18–79) Male, (%) 67.8 Race, (%) White 70.1 Hispanic 14.0 African American 9.1 Asian 3.4 Other 3.4 Underlying liver disease (%) Hepatitis C 36.4 Alcohol 27.6 Cryptogenic 11.0 Hepatitis B 5.8 Autoimmune hepatitis 4.9 Nonalcoholic steatosis 2.4 α-1 Antitrypsin 2.1 Wilson's 0.2 Sarcoid 0.2 PSC 1.8 PBC 1.1 Drug induced 0.6 Amyloid 0.3 Other 5.6
Discussion
The major findings of this prospective study are that the MELD score, which is based on 3 simple variables (serum bilirubin, serum creatinine, and INR) is able to accurately estimate 3-month mortality in patients with chronic end-stage liver disease. These findings are consistent with a number of retrospective studies, which were used to validate the MELD score as a liver disease severity index.8, 9 Our results demonstrate that the MELD score is superior to the CTP score in ranking patients
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Address requests for reprints to: Russell H. Wiesner, M.D., Professor of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905. e-mail: [email protected]; fax: (507) 266-2810.
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The United Network for Organ Sharing Liver Disease Severity Score Committee includes the following: Chairman Dr. Russell H. Wiesner, Rochester Methodist Hospital Mayo Clinic; Dr. Paul M. Colombani, Johns Hopkins Hospital; Mrs. Paige C. Cottingham Streater, General Health Pharm Ins.; Dr. Stephen P. Dunn, Alfred I. DuPont Hospital for Children; Dr. Richard B. Freeman, New England Medical Center; Dr. John J. Fung, University of Pittsburgh Medical Center and Oakland VA Medical Center; Dr. Douglas W. Hanto, Beth Israel Deaconess Medical Center; Dr. Todd K. Howard, St. Louis, Missouri; Dr. John R. Lake, Fairview University Medical Center; Dr. Sue V. McDiarmid, University of California at Los Angeles Medical Center; Dr. John M. Rabkin, Oregon Health Sciences University Hospital and Portland VA Medical Center; Dr. Lewis W. Teperman, New York University Medical Center; Dr. Jeremiah G. Turcotte, University of Michigan Medical Center; and Ms. Lynn Rothberg Wegman, Division of Organ Transplantation, HHS.