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Survival Tree and Meld to Predict Long Term Survival in Liver Transplantation Waiting List

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Abstract

MELD score is a formula based on laboratory variables used as a predictor of short-term mortality index in cirrhotic patients. It is applied to allocate patients in liver transplantation waiting list in many countries. However, MELD score cutoff point accuracy to predict long term mortality has not been statistically evaluated. The aim of this study was to analyze the MELD score and other variables related to long-term mortality using a new model: the Survival Tree analysis. The variables considered in this study were obtained at the time of liver transplantation list enrollment. The graphical representation of the survival trees showed that MELD 16 was the most statistically significant mortality cutoff point. The results were compatible with the MELD cutoff point reported in the clinical literature. This methodology can be extended to identify significant cutoff points related to other diseases whose severity is not necessarily expressed by MELD.

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References

  1. Kamath, P. S., Wiesner, R. H., Malinchoc, M., Kremers, W., Therneau, T. M., Kosberg, C. L., et al., A model to predict survival in patients with end-stage liver disease. Hepatology 33(2):464–470, 2001.

    Article  Google Scholar 

  2. Edwards, E. B., and Harper, A. M., Application of a continuous disease severity score to the OPTN liver waiting list. Clin. Transpl. 19–24, 2001.

  3. Fink, M. A., Angus, P. W., Gow, P. J., Berry, S. R., Wang, B. Z., Muralidharan, V., et al., Liver transplant recipient selection: MELD vs. clinical judgment. Liver. Transpl. 11(6):621–626, 2005.

    Article  Google Scholar 

  4. Zapata, R., Innocenti, F., Sanhueza, E., Humeres, R., Rios, H., Suarez, L., et al., Clinical characterization and survival of adult patients awaiting liver transplantation in Chile. Transplant. Proc. 36(6):1669–1670, 2004.

    Article  Google Scholar 

  5. Ransford, R., Gunson, B., Mayer, D., Neuberger, J., and Christensen, E., Effect on outcome of the lengthening waiting list for liver transplantation. Gut 47(3):441–443, 2000.

    Article  Google Scholar 

  6. Fink, M. A., Berry, S. R., Gow, P. J., Angus, P. W., Wang, B.-Z., Muralidharan, V., et al., Risk factors for liver transplantation waiting list mortality. J. Gastroenterol. Hepatol. 22(1):119–124, 2007.

    Article  Google Scholar 

  7. Adler, M., DeGendt, E., Vereerstraeten, P., Degré, D., Bourgeois, N., Boon, N., et al., Value of the MELD score for the assessment of pre- and post-liver transplantation survival. Transplant. Proc. 37(6):2863–2864, 2005.

    Article  Google Scholar 

  8. Lee, Y. M., Fernandes, M., DaCosta, M., Lee, K. H., Sutedja, D., Tai, B. C., et al., The MELD score may help to determine optimum time for liver transplantation. Transplant. Proc. 36(10):3057–3059, 2004.

    Article  Google Scholar 

  9. Hothorn, T., Hornik, K., and Zeileis, A., Unbiased Recursive Partitioning: A Conditional Inference Framework. Journal of Computational and Graphical Statistics 15(3):651–674, 2006.

    Article  MathSciNet  Google Scholar 

  10. Cox, D. R., Regression Models and Life-Tables (with discussion). Journal of the Royal Statistical Society Series B 34(2):187–220, 1972.

    MATH  Google Scholar 

  11. R Development Core Team, R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, 2009.

  12. Everitt, B. S., and Hothorn, T., A Handbook of Statistical Analyses Using R. Chapman & Hall-CRC Press, Boca Raton, 2006.

    Book  Google Scholar 

  13. Strasser, H., and Weber, C., On the asymptotic theory of permutation statistics. Mathematical Methods of Statistics 8:220–250, 1999.

    MathSciNet  MATH  Google Scholar 

  14. Perkins, J. D., Halldorson, J. B., Bakthavatsalam, R., Fix, O. K., Carithers, R. L., Jr., and Reyes, J. D., Should liver transplantation in patients with model for end-stage liver disease scores ≤14 be avoided? A decision analysis approach. Liver. Transpl. 15(2):242–254, 2009.

    Article  Google Scholar 

  15. Thuluvath, P. J., Maheshwari, A., Thuluvath, N. P., Nguyen, G. C., and Segev, D. L., Survival after liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease and pre-model for end-stage liver disease eras and the independent impact of hepatitis C virus. Liver Transpl. 15(7):754–762, 2009.

    Article  Google Scholar 

  16. Boin, I. F. S. F., Leonardi, M. I., Pinto, A. O., Leme, R. S. R., Udo, E., Stucchi, R. S. B., et al., Liver transplant recipients mortality on the waiting list: long-term comparison to Child-Pugh classification and MELD. Transplant. Proc. 36(4):920–922, 2004.

    Article  Google Scholar 

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Authors and Affiliations

  1. Federal University of Rio de Janeiro, COPPE - Postgraduate School of Engineering; HUCFF - University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil

    Emília Matos do Nascimento

  2. UFRJ - Federal University of Rio de Janeiro, HUCFF - University Hospital Clementino Fraga Filho; FM - School of Medicine; COPPE - Postgraduate School of Engineering, Rio de Janeiro, Brazil

    Basilio de Bragança Pereira

  3. UFRJ - Federal University of Rio de Janeiro, HUCFF - University Hospital Clementino Fraga Filho; FM - School of Medicine, Rio de Janeiro, Brazil

    Samanta Teixeira Basto & Joaquim Ribeiro Filho

Authors
  1. Emília Matos do Nascimento
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  2. Basilio de Bragança Pereira
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  3. Samanta Teixeira Basto
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  4. Joaquim Ribeiro Filho
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Correspondence to Emília Matos do Nascimento.

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do Nascimento, E.M., Pereira, B.B., Basto, S.T. et al. Survival Tree and Meld to Predict Long Term Survival in Liver Transplantation Waiting List. J Med Syst 36, 73–78 (2012). https://doi.org/10.1007/s10916-010-9447-6

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  • DOI: https://doi.org/10.1007/s10916-010-9447-6

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