Jacques Belghiti, Safi Dokmak, in Blumgart's Surgery of the Liver, Pancreas and Biliary Tract (Fifth Edition), 2012 Model for End-Stage Liver Disease Score Although this has been demonstrated for PSC, 107 there are no specific data examining this issue with respect to PBC to date. 105,106 With over a decade of experience using the MELD score for LT, there are questions about PBC having a disadvantage in terms of waiting list time as compared to non–cholestatic liver disease. However, the influence of liver disease cause on MELD score was eliminated from the model when UNOS implementation was undertaken. It should be noted that the original MELD study recognized that patients with cholestatic liver disease had improved predicted survival as compared to other types of liver disease.
Subsequent analysis demonstrated that the MELD score was equivalent to the Mayo PBC risk score for predicting survival in PBC patients. 104 In this cohort the MELD score was associated with a very high discriminative value of 0.87 (95% confidence interval, 0.71-1.00) for mortality at 3 months that remained at the same (0.87) value when assessing 1-year mortality. The original MELD score was based on a predictive survival model described for patients receiving transjugular intrahepatic portosystemic shunt. 102,103 The MELD score involves three readily available laboratory values: serum total bilirubin, creatinine, and international normalized ratio (INR). The MELD score was adopted in February 2002 by UNOS to guide organ allocation policies. Talwalkar, in Transplantation of the Liver (Third Edition), 2015 MELD Scores in Patients with Primary Biliary Cirrhosis
0 kommentar(er)
