Table of Contents
ISRN Transplantation
Volume 2013, Article ID 102590, 7 pages
http://dx.doi.org/10.5402/2013/102590
Clinical Study

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

1Hepatology Unit, Hospital Italiano de Buenos Aires, Avenida Presidente Perón 1500, Derqui, B1629HJ Buenos Aires, Argentina
2Liver Transplant Unit, Hospital Italiano de Buenos Aires, Avenida Presidente Perón 1500, Derqui, B1629HJ Buenos Aires, Argentina
3Adult Intensive Care Unit, Hospital Italiano de Buenos Aires, Avenida Presidente Perón 1500, Derqui, B1629HJ Buenos Aires, Argentina

Received 23 May 2013; Accepted 21 August 2013

Academic Editors: A. D. Hess and A. Jaramillo

Copyright © 2013 Federico Piñero et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.