Agustos 2008
Karaciger transplantasyon önceligini belirlemede hangi model etkin; MELD skoru? CHILD Skoru ?
Which model is more effective for prioritizing liver transplantation: MELD or CHILD score?
- Ana Sayfa
- Sayılar
- Agustos 2008
- Karaciger transplantasyon önceligini belirlemede hangi model etkin; MELD skoru? CHILD Skoru ?...
Ankara Numune Egitim ve Arastirma Hastanesi, Gastroenteroloji Klinigi4, Ankara
Özet
Giris ve Amaç: Karaciger transplantasyon karari verilen ve bekleme listesine alinan olgularda, transplantasyon zamaninin belirlenmesi, özellikle organ bulma sikintisinin olmasi, bekleme listesindeki hasta sayisinin giderek artmasi ve canli donörden karaciger nakillerinin gündeme gelmesi ile daha da önem kazanmis durumdadir. Bu çalismada erken transplantasyonu önlemek, bekleme listesindeki hasta kaybini en aza indirgemek, transplantasyon zamanini ve önceligini saptamak açisindan MELD (Model for End-stage Liver Disease) ve CHILD (Child-Pugh) skorlarinin yerini belirlemeyi amaçladik. Gereç ve Yöntem: Karaciger sirozu tanisi alan ve KCTx programina alinan olgularin CHILD ve MELD skorlarini belirlemek için PT, INR, Albümin, bilirübin, üre, kreatinin degerlerine bakildi. Asit varligini belirlemek için tüm olgulara batin ultrasonografisi yapildi. Ensefalopati varligi ve derecesi belirlendi. CHILD skoruna göre olgular CHILD A, B, C diye üç gruba ayrildi. MELD skoruna göre ise olgular <10; 10-20 arasi ve 20< (21-40) olacak sekilde kategorize edildi. Istatiksel islemler için Kaplan-Meier, student–t testi ve korelasyon testleri (SPSS for Windows 10) kullanildi. Bulgular: Transplantasyon programina alinan 110 olgu (22 kadin, 88 Erkek, ortalama yas;40.35±11.99 sinirlar;16-64 yil) retrospektif olarak incelendi. Hastalarin transplantasyon listesinde bekleme sürelerince hem CHILD, hem de MELD skorlarinda anlamli progresyon gözlendi (8.23±1.87 vs. 9.18±2.89; 15.20±5.02 vs. 16.59±6.09, p<0.0001, p=0.02, sirasiyla). CHILD ve MELD skoru arasinda pozitif korelasyon vardi (r=0.687, p=0.01). Child A’da ortalama yasam süresi 64 ayken, bu süre Child C’de 24 aydi. MELD skoru <10’un altinda olan 10 olgunun hepsi yasarken, MELD skoru 10-20 arasinda olanlari n ortalama sagkalim süresi 50 ay, 20’nin üzerinde olanlarda ise bu süre 14 aya düsmüstür. Sonuç: transplantasyon bekleme listesinde hasta önceliginin belirlenmesinde MELD skoru CHILD skoruna göre daha üstün gibi gözükmekle birlikte çalismanin retrospektif olmasi bu sonuca varmada yetersiz olabilir. Transplantasyon zamanini belirlemede, kadavra bulma sikintisinin çok oldugu ülkemizde pek çok parametrenin kombine kullaniminin gerekecegi düsüncesindeyiz.
Abstract
Background and Aims: Prioritization in liver transplantation is very important because of the ever-growing liver transplant waiting list and the shortage of deceased donors and even more new options of liver-living donors. The aim of our study was to evaluate the Child-Pugh and Model for End-Stage Liver Disease (MELD) scores with respect to their value in predicting the priority of liver transplantation, to prevent early transplantation and reduce waiting-list mortality. Materials and Methods: Patients diagnosed with end stage liver disease on the waiting list for liver transplant were included in this study. Prothrombin time, INR, serum albumin, bilirubin, urea, and creatinine levels were determined for measurement of Child- Pugh and MELD score. Child-Pugh and MELD values were calculated at baseline and in the follow-up period. All patients underwent abdominal ultrasonography for the detection of ascites. The grade of encephalopathy was noted. According to the Child-Pugh classification, the patients were categorized as A: 5 to 6, B: 7 to 9, and C: 10 to 15. MELD score was computed for each patient according to the original formula. MELD score was stratified into three groups: 0 to 10; 11 to 20; and 21 to 40. Student’s t-test and correlation test were used for statistical analysis. Survival over the entire period was examined with Kaplan-Meier analysis (SPSS for Windows 10). Results: One hundred and ten patients (22 F, 88 M; mean age: 40.35±11.99, range: 16-64 years) on the transplant waiting list were evaluated retrospectively. During the follow-up, progression of both MELD and Child-Pugh scores was compared to the time of listing (r=0.687, p=0.01). While the mean survival time in the patients with Child A was 64 months, in Child C, mean survival was 24 months. While all patients with MELD score less than 10 points were alive, mean survival time was 50 months between 10-20 points, and 14 months for MELD score over 20 points. Conclusions: It was concluded that the MELD score seems more reliable than Child-Pugh with respect to selecting the priority of liver transplantation; however, more prospective studies are required. Analysis of many parameters for prioritization of liver transplantation is needed in our country, in view of the very low rate of donation of deceased organs.
