Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina

PIÑERO, FEDERICO; MARCIANO, SEBASTIÁN; VILLAMIL, ALEJANDRA; BANDI, JUAN; CASCIATO, PAOLA; GALDAME, OMAR; GIANNASI, SERGIO; DE SANTIBAÑES, EDUARDO; GADANO, ADRIAN

ISRN Transplantation

Hindawi

Año: 2013 vol. 2013 p. 1 - 7

Background. MELD or MELD sodium promotes sicker patients for earlier liver transplantation (LT); the balance between pre- and post-LT outcomes is still controversial. Aim. To compare MELD and related scores? risk assessment of short-term morbidity and mortality after LT. Methods. We included only transplanted cirrhotic patients from 6/2005 to 6/2010 (). Immediate pre-LT MELD, integrated MELD (iMELD), and two MELD sodium formulas ?MELD Na1? and ?MELDNa2? were calculated. Results. Pre-LT scores for nonsurvivors were higher than those for survivors: MELD (28 ± 8 versus 22 ± 7, ), MELD Na1 (33 ± 8 versus 27 ± 10, ), and iMELD (51 ± 6 versus 46 ± 8, ). Patient survival assessment was performed by AUROC analysis (95% CI): MELD 0.694 (0.56?0.82; ), MELD Na1 0.682 (0.56?0.79; ), MELD Na2 0.651 (0.54?0.76; ), and iMELD 0.698 (0.593?0.80; ). Patients with MELD ≥25 points had longer intensive care stay (mean 10 versus 7 days, ) and longer mechanical ventilatory support (5.4 versus 1.9 days, ). Conclusions. The addition of serum sodium to MELD does not improve assessment of mortality after LT. Patients with higher MELD may preclude higher morbidity after transplantation.