Dutkowski et al developed a score for evaluating a patient with end-stage liver disease who requires a liver transplant. This can help to identify a recipient who may have a poor prognosis. The author are from University Hospital Zurich and the Johns Hopkins University.
Patient selection: end-stage liver disease requiring transplantation
Parameters:
(1) age of the recipient
(2) MELD score of recipient at the time of transplant
(3) retransplantation
(4) life support prior to transplant
(5) cold ischemia time in hours
(6) donor age in years
Parameter
Finding
Points
recipient's age
<= 40 years
0
40.01 to 60 years
1
> 60 years
3
MELD score
<= 15
0
15.01 to 25
5
25.01 to 35
10
> 35
14
retransplantation
no
0
yes
4
life support
no
0
yes
3
cold ischemia time
<= 6 hours
0
6.01 to 12 hours
1
> 12 hours
2
donor's age
<= 40 years
0
> 40 years
1
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 27
• The higher the score the greater the mortality.
• For a patient with a MELD score >= 30, survival was worse if the BAR was > 18.
Total Score
7-Year Overall Survival
<= 15
66%
16 to 20
54%
> 20
30%
Performance:
• Internal validation area under the ROC curve was 0.70.
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