Skip to main content
SpringerLink
Log in

Use of the Model for End-Stage Liver Disease (MELD) score to predict 1-year survival of Japanese patients with cirrhosis and to determine who will benefit from living donor liver transplantation

  • Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Consideration of the prognosis of patients with liver cirrhosis is important when determining the appropriate timing of liver transplantation. Especially in Japan, where 99% of liver transplants are from living donors, timing is very important not only for the patient but also for the family, who need time to consider the various factors involved in living donations.

Methods

To clarify the applicability of the Model for End-Stage Liver Disease (MELD) score in Japanese patients with cirrhosis, changes in the MELD score over 24 months were reviewed in 79 patients with cirrhosis who subsequently died of liver failure (n = 33) or who survived 24 months (n = 46). All patients had Child class B or C cirrhosis at the start of follow-up. We also compared their survival with that of 30 patients treated by living donor liver transplantation (LDLT) in our institute to determine the proper timing of transplantation in patients with cirrhosis.

Results

Significant stratification of survival curves was observed for MELD scores of <12, 12–15, 15–18, and >18 (P = 0.0018). A significant survival benefit of LDLT was observed in patients with MELD score ≥15 (P = 0.0181), and significantly more risk with transplantation was observed in those with MELD score <15 compared with that of patients in whom the disease followed its natural course (P = 0.0168).

Conclusions

MELD score is useful for predicting 1-year survival in Japanese patients with cirrhosis. MELD scores of 15 had discriminatory value for indicating a survival benefit to be gained by liver transplantation and thus can be used to help patients and their families by identifying patients who would benefit from LDLT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arroyo V, Gines A, Salo J. A European survey on the treatment of ascites in cirrhosis. J Hepatol 1994;21:667–672.

    Article  PubMed  CAS  Google Scholar 

  2. Lucena MI, Andrade RJ, Tognoni G, Hidalgo R, De La Cuesta FS. Multicenter hospital study on prescribing patterns for prophylaxis and treatment of complications of cirrhosis. Eur J Clin Pharmacol 2002;58:435–440.

    Article  PubMed  CAS  Google Scholar 

  3. Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology 1998;27:264–272.

    Article  PubMed  CAS  Google Scholar 

  4. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. The North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. N Engl J Med 1988;319:983–989.

  5. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001;33:802–807.

    Article  PubMed  CAS  Google Scholar 

  6. Pagliaro L, D’Amico G, Sorensen TI, Lebrec D, Burroughs AK, Morabito A, et al. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med 1992;117:59–70.

    PubMed  CAS  Google Scholar 

  7. Sheer TA, Runyon BA. Spontaneous bacterial peritonitis. Dig Dis 2005;23:39–46.

    Article  PubMed  Google Scholar 

  8. Planas R, Balleste B, Alvarez MA, Rivera M, Montoliu S, Galeras JA, et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol 2004;40:823–830.

    Article  PubMed  Google Scholar 

  9. Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol 1993;18:353–358.

    Article  PubMed  CAS  Google Scholar 

  10. Garcia-Tsao G. Spontaneous bacterial peritonitis. Gastroenterol Clin North Am 1992;21:257–275.

    PubMed  CAS  Google Scholar 

  11. Novella M, Sola R, Soriano G, Andreu M, Gana J, Ortiz J, et al. Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin. Hepatology 1997;25:532–536.

    Article  PubMed  CAS  Google Scholar 

  12. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000;32:142–153.

    Article  PubMed  CAS  Google Scholar 

  13. Sandhu BS, Gupta R, Sharma J, Singh J, Murthy NS, Sarin SK. Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites. J Gastroenterol Hepatol 2005;20:599–605.

    Article  PubMed  CAS  Google Scholar 

  14. Toledo C, Salmeron JM, Rimola A, Navasa M, Arroyo V, Llach J, et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology 1993;17:251–257.

    Article  PubMed  CAS  Google Scholar 

  15. Chalasani N, Horlander JC Sr, Said A, Hoen H, Kopecky KK, Stockberger SM Jr, et al. Screening for hepatocellular carcinoma in patients with advanced cirrhosis. Am J Gastroenterol 1999;94:2988–2993.

    Article  PubMed  CAS  Google Scholar 

  16. Dahlke MH, Popp FC, Eggert N, Hoy L, Tanaka H, Sasaki K, et al. Differences in attitude toward living and postmortal liver donation in the United States, Germany, and Japan. Psychosomatics 2005;46:58–64.

    Article  PubMed  Google Scholar 

  17. Kiuchi T, Tanaka K. Liver transplantation from living donors: current status in Japan and safety/long-term results in the donor. Transplant Proc 2003;35:1172–1173.

    Article  PubMed  CAS  Google Scholar 

  18. Shimada M, Fujii M, Morine Y, Imura S, Ikemoto T, Ishibashi H. Living-donor liver transplantation: present status and future perspective. J Med Invest 2005;52:22–32.

    Article  PubMed  Google Scholar 

  19. Tanaka K, Yamada T. Living donor liver transplantation in Japan and Kyoto University: what can we learn? J Hepatol 2005;42:25–28.

    Article  PubMed  Google Scholar 

  20. Todo S, Furukawa H, Jin MB, Shimamura T. Living donor liver transplantation in adults: outcome in Japan. Liver Transpl 2000;6:S66–S72.

    Article  PubMed  CAS  Google Scholar 

  21. Adam R, McMaster P, O’Grady JG, Castaing D, Klempnauer JL, Jamieson N, et al. Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003;9:1231–1243.

    Article  PubMed  Google Scholar 

  22. Bak T, Wachs M, Trotter J, Everson G, Trouillot T, Kugelmas M, et al. Adult-to-adult living donor liver transplantation using rightlobe grafts: results and lessons learned from a single-center experience. Liver Transpl 2001;7:680–686.

    Article  PubMed  CAS  Google Scholar 

  23. Boillot O, Belghiti J, Azoulay D, Gugenheim J, Soubrane O, Cherqui D. Initial French experience in adult-to-adult living donor liver transplantation. Transplant Proc 2003;35:962–963.

    Article  PubMed  CAS  Google Scholar 

  24. Broelsch CE, Malago M, Testa G, Valentin Gamazo C. Living donor liver transplantation in adults: outcome in Europe. Liver Transpl 2000;6:S64–S65.

    Article  PubMed  CAS  Google Scholar 

  25. Brown RS Jr, Russo MW, Lai M, Shiffman ML, Richardson MC, Everhart JE, et al. A survey of liver transplantation from living adult donors in the United States. N Engl J Med 2003;348:818–825.

    Article  PubMed  Google Scholar 

  26. Chen CL, Fan ST, Lee SG, Makuuchi M, Tanaka K. Living-donor liver transplantation: 12 years of experience in Asia. Transplantation 2003;75:S6–S11.

    Article  PubMed  Google Scholar 

  27. Malago M, Testa G, Frilling A, Nadalin S, Valentin-Gamazo C, Paul A, et al. Right living donor liver transplantation: an option for adult patients: single institution experience with 74 patients. Ann Surg 2003;238:853–862; discussion 862–3.

    Article  PubMed  Google Scholar 

  28. Sugawara Y, Makuuchi M. Advances in adult living donor liver transplantation: a review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in Tokyo. Liver Transpl 2004;10:715–720.

    Article  PubMed  Google Scholar 

  29. Adam R, Lucidi V, Karam V. Liver transplantation in Europe: is there a room for improvement? J Hepatol 2005;42:33–40.

    Article  PubMed  Google Scholar 

  30. Bilbao I, Figueras J, Grande L, Cleries M, Jaurrieta E, Visa J, et al. Risk factors for death following liver retransplantation. Transplant Proc 2003;35:1871–1873.

    Article  PubMed  CAS  Google Scholar 

  31. Hunt CM, Camargo CA Jr, Dominitz JA, Bute BP, Clavien PM. Effect of postoperative complications on health and employment following liver transplantation. Clin Transplant 1998;12:99–103.

    PubMed  CAS  Google Scholar 

  32. Lee SG, Park KM, Lee YJ, Hwang S, Choi DR, Ahn CS, et al. 157 adult-to-adult living donor liver transplantation. Transplant Proc 2001;33:1323–1325.

    Article  PubMed  CAS  Google Scholar 

  33. Lo CM, Fan ST, Liu CL, Yong BH, Wong Y, Lau GK, et al. Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg 2004;240:151–158.

    Article  PubMed  Google Scholar 

  34. Matinlauri IH, Nurminen MM, Hockerstedt KA, Isoniemi HM. Risk factors predicting survival of liver transplantation. Transplant Proc 2005;37:1155–1160.

    Article  PubMed  CAS  Google Scholar 

  35. Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, et al. The survival benefit of liver transplantation. Am J Transplant 2005;5:307–313.

    Article  PubMed  Google Scholar 

  36. Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL consortium. Ann Surg 2005;242:314–325.

    PubMed  Google Scholar 

  37. Settmacher U, Theruvath T, Pascher A, Neuhaus P. Living-donor liver transplantation—European experiences. Nephrol Dial Transplant 2004;19Suppl 4:iv16–iv21.

    Article  PubMed  Google Scholar 

  38. Smith CM, Davies DB, McBride MA. Liver transplantation in the United States: a report from the Organ Procurement and Transplantation Network. Clin Transpl 2000;19–30.

  39. Testa G, Malago M, Valentin-Gamazo C, Lindell G, Broelsch CE. Biliary anastomosis in living related liver transplantation using the right liver lobe: techniques and complications. Liver Transpl 2000;6:710–714.

    Article  PubMed  CAS  Google Scholar 

  40. Thuluvath PJ, Yoo HY, Thompson RE. A model to predict survival at one month, one year, and five years after liver transplantation based on pretransplant clinical characteristics. Liver Transpl 2003;9:527–532.

    Article  PubMed  Google Scholar 

  41. Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med 2002;346:1074–1082.

    Article  PubMed  Google Scholar 

  42. Heuman DM, Mihas A. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology 2003;125:992–993; author reply 994–5.

    Article  PubMed  Google Scholar 

  43. Surman OS. The ethics of partial-liver donation. N Engl J Med 2002;346:1038.

    Article  PubMed  Google Scholar 

  44. Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K, et al. Operative morbidity of living liver donors in Japan. Lancet 2003;362:687–690.

    Article  PubMed  Google Scholar 

  45. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–470.

    Article  PubMed  CAS  Google Scholar 

  46. Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlich J, et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut 2003;52:879–885.

    Article  PubMed  CAS  Google Scholar 

  47. Boin IF, Leonardi MI, Pinto AO, Leme RS, Udo E, Stucchi RS, et al. Liver transplant recipients mortality on the waiting list: long-term comparison to Child-Pugh classification and MELD. Transplant Proc 2004;36:920–922.

    Article  PubMed  CAS  Google Scholar 

  48. Botta F, Giannini E, Romagnoli P, Fasoli A, Malfatti F, Chiarbonello B, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003;52:134–139.

    Article  PubMed  CAS  Google Scholar 

  49. Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, et al. Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding. Hepatology 2002;35:1282–1284.

    Article  PubMed  Google Scholar 

  50. Dunn W, Jamil LH, Brown LS, Wiesner RH, Kim WR, Menon KV, et al. MELD accurately predicts mortality in patients with alcoholic hepatitis. Hepatology 2005;41:353–358.

    Article  PubMed  Google Scholar 

  51. Giannini E, Botta F, Testa R. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology 2003;125:993–994; author reply 994–5.

    Article  PubMed  Google Scholar 

  52. Russo MW, Brown RS, Jr. Adult living donor liver transplantation. Am J Transplant 2004;4:458–465.

    Article  PubMed  Google Scholar 

  53. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application of survival models to liver allocation. Liver Transpl 2001;7:567–580.

    Article  PubMed  CAS  Google Scholar 

  54. Papatheodoridis GV, Cholongitas E, Dimitriadou E, Touloumi G, Sevastianos V, et al. MELD vs Child-Pugh and creatinine-modified Child-Pugh score for predicting survival in patients with decompensated cirrhosis. World J Gastroenterol 2005;11:3099–3104.

    PubMed  Google Scholar 

  55. Salerno F, Merli M, Cazzaniga M, Valeriano V, Rossi P, Lovaria A, et al. MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 2002;36:494–500.

    Article  PubMed  Google Scholar 

  56. Gheorghe L, Popescu I, Iacob R, Iacob S, Gheorghe C. Predictors of death on the waiting list for liver transplantation characterized by a long waiting time. Transpl Int 2005;18:572–576.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Masatoshi Ishigami, Takashi Honda, Yoshiaki Katano & Hidemi Goto

  2. Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan

    Akihiko Okumura & Tetsuya Ishikawa

  3. Department of Gastroenterology, Yokkaichi City Hospital, Yokkaichi, Japan

    Makoto Kobayashi

  4. Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan

    Yasuhiro Fujimoto & Tetsuya Kiuchi

Authors
  1. Masatoshi Ishigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akihiko Okumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tetsuya Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Makoto Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshiaki Katano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuhiro Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tetsuya Kiuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hidemi Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ishigami, M., Honda, T., Okumura, A. et al. Use of the Model for End-Stage Liver Disease (MELD) score to predict 1-year survival of Japanese patients with cirrhosis and to determine who will benefit from living donor liver transplantation. J Gastroenterol 43, 363–368 (2008). https://doi.org/10.1007/s00535-008-2168-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-008-2168-7

Key words

Search

Navigation