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The MELD score predicts the short-term and overall survival after liver transplantation in patients with primary sclerosing cholangitis or autoimmune liver diseases

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Abstract

Purpose

Liver transplantation (LT) is well established in patients with autoimmune liver disease. Despite excellent outcomes, organ scarcity demands careful patients’ selection and timing of transplantation.

Methods

This retrospective study analyzes data of 79 consecutive patients with primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and overlap syndrome, undergoing LT between 2001 and 2012. Overall survival (OS) and graft survival were assessed using Kaplan-Meier estimate. Multivariate survival analysis was performed to identify prognostic factors by using Cox regression model.

Results

After 59.6-month median follow-up, the 5-year OS and graft survival were 75.3 and 68.8 %, respectively. The 5-year survival rates for patients with PSC (n = 57), AIH (n = 17), and overlap syndrome (n = 5) were 76.3, 76.0, and 60.0 %. The 90-day mortality rate of 70.0 % was significantly higher in patients with a labMELD score ≥20 (n = 10) compared to 26.1 % in 69 patients with a labMELD <20 (p = 0.009). A lab Model for End-Stage Liver Disease (MELD) score ≥20 was an independent predictor of impaired OS (p = 0.050, hazard ratio 2.5). The 5-year OS was 55.7 % in patients with a labMELD score ≥20 compared to 84.7 % in patients with a labMELD score <20.

Conclusion

The recipients’ MELD score is a predictor for the short-term outcome after LT in patients with autoimmune liver disease. Meticulous selection for transplant listing remains necessary to safe scarce donor organs.

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Abbreviations

AIH:

Autoimmune hepatitis

CCC:

Cholangiocarcinoma

ERC:

Endoscopic retrograde cholangiography

HCC:

Hepatocellular carcinoma

IQR:

Interquartile range

IVC:

Inferior vena cava

IBD:

Inflammatory bowel disease

LFTs:

Liver function tests

LT:

Liver transplantation

OS:

Overall survival

PBC:

Primary biliary cirrhosis

PSC:

Primary sclerosing cholangitis

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Conflicts of interest

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Author information

Authors and Affiliations

  1. Department of General and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Katrin Hoffmann, Ulf Hinz, Norbert Hillebrand & Peter Schemmer

  2. Department of Internal Medicine, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Tom Ganten & Daniel Gotthardt

  3. Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany

    Thomas Longerich & Peter Schirmacher

Authors
  1. Katrin Hoffmann
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  2. Ulf Hinz
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  3. Norbert Hillebrand
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  4. Tom Ganten
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  6. Thomas Longerich
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  7. Peter Schirmacher
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  8. Peter Schemmer
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Correspondence to Peter Schemmer.

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Hoffmann, K., Hinz, U., Hillebrand, N. et al. The MELD score predicts the short-term and overall survival after liver transplantation in patients with primary sclerosing cholangitis or autoimmune liver diseases. Langenbecks Arch Surg 399, 1001–1009 (2014). https://doi.org/10.1007/s00423-014-1237-z

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  • DOI: https://doi.org/10.1007/s00423-014-1237-z

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