Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation
BackgroundThe pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortal...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Anesthesiologists
2010-09-01
|
| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kjae-59-160.pdf |
| _version_ | 1818203031096786944 |
|---|---|
| author | Won Jung Hwang Joon Pyo Jeon Seung Hee Kang Hyun Sik Chung Ji Yong Kim Chul Soo Park |
| author_facet | Won Jung Hwang Joon Pyo Jeon Seung Hee Kang Hyun Sik Chung Ji Yong Kim Chul Soo Park |
| author_sort | Won Jung Hwang |
| collection | DOAJ |
| description | BackgroundThe pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality.MethodsPerioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox's proportional hazards regression.ResultsThe 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P < 0.05). After multivariate analyses, declines in post-MELD scores until the 5th day of less than 5 points (hazard ratio 2.35, P = 0.007) and prolonged mechanical ventilation ≥24 hours were the earliest independent predictors of 1-year mortality.ConclusionsA sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT. |
| first_indexed | 2024-12-12T03:18:52Z |
| format | Article |
| id | doaj.art-2bef54a9ff1d4bb696a2b8540196254e |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-12-12T03:18:52Z |
| publishDate | 2010-09-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-2bef54a9ff1d4bb696a2b8540196254e2022-12-22T00:40:13ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632010-09-0159316016610.4097/kjae.2010.59.3.1606942Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantationWon Jung Hwang0Joon Pyo Jeon1Seung Hee Kang2Hyun Sik Chung3Ji Yong Kim4Chul Soo Park5Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.BackgroundThe pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality.MethodsPerioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox's proportional hazards regression.ResultsThe 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P < 0.05). After multivariate analyses, declines in post-MELD scores until the 5th day of less than 5 points (hazard ratio 2.35, P = 0.007) and prolonged mechanical ventilation ≥24 hours were the earliest independent predictors of 1-year mortality.ConclusionsA sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.http://ekja.org/upload/pdf/kjae-59-160.pdfliver transplantationliving donormortalityprediction |
| spellingShingle | Won Jung Hwang Joon Pyo Jeon Seung Hee Kang Hyun Sik Chung Ji Yong Kim Chul Soo Park Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation Korean Journal of Anesthesiology liver transplantation living donor mortality prediction |
| title | Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation |
| title_full | Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation |
| title_fullStr | Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation |
| title_full_unstemmed | Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation |
| title_short | Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation |
| title_sort | sluggish decline in a post transplant model for end stage liver disease score is a predictor of mortality in living donor liver transplantation |
| topic | liver transplantation living donor mortality prediction |
| url | http://ekja.org/upload/pdf/kjae-59-160.pdf |
| work_keys_str_mv | AT wonjunghwang sluggishdeclineinaposttransplantmodelforendstageliverdiseasescoreisapredictorofmortalityinlivingdonorlivertransplantation AT joonpyojeon sluggishdeclineinaposttransplantmodelforendstageliverdiseasescoreisapredictorofmortalityinlivingdonorlivertransplantation AT seungheekang sluggishdeclineinaposttransplantmodelforendstageliverdiseasescoreisapredictorofmortalityinlivingdonorlivertransplantation AT hyunsikchung sluggishdeclineinaposttransplantmodelforendstageliverdiseasescoreisapredictorofmortalityinlivingdonorlivertransplantation AT jiyongkim sluggishdeclineinaposttransplantmodelforendstageliverdiseasescoreisapredictorofmortalityinlivingdonorlivertransplantation AT chulsoopark sluggishdeclineinaposttransplantmodelforendstageliverdiseasescoreisapredictorofmortalityinlivingdonorlivertransplantation |