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MELD SCORE
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MELD SCORE

I think anyone waiting for a liver transplant will find this article of significant interest. This is the section on MELD score but the article addresses the following issues:  
  
    * General Principles and Natural History of Cirrhosis
    * Child's Score
    * Meld Score
    * Meld Score Derivatives
    * Prognosis According to Specific Causes of Cirrhosis
    * Prognosis in the Particular Setting of Nontransplant Surgery
    * Prognosis in the Particular Setting of the Intensive Care Unit
    * Prognosis in the Particular Setting of Transplantation
    * Which Prognostic Tool to Use for Assessing the Prognosis of Cirrhosis?
    * Perspectives: Beyond MELD Score

The entire article is at:  http://www.medscape.com/viewarticle/572659_11


Meld Score
Definitions

While Child score was originally designed for assessing the prognosis of cirrhotic patients undergoing surgical treatment of portal hypertension, MELD score was designed for assessing the prognosis of cirrhotic patients
undergoing transjugular portosystemic intrahepatic shunt (TIPS).[24] Multivariate analysis using Cox regression analysis showed that among a list of pre-determined variables, four variables had an independent impact on survival, namely bilirubin, creatinine, INR, and the cause of cirrhosis (alcoholic and cholestatic versus other causes). To lessen the influence of extreme values, the natural logarithm of bilirubin INR and creatinine were entered into the model. Based on regression analysis, a coefficient was attached to each variable, according to the weight of each variable on mortality risk. In the original series, the resulting score was slightly more accurate than Child-Pugh score for predicting survival after TIPS.

With the expansion of liver transplantation, attention moved from the management of portal hypertension to waiting list mortality and organ allocation policy in patients listed for transplantation. Indeed, waiting time alone proved to be an inaccurate marker of waiting list mortality[27] and more relevant markers were needed. A slightly modified risk score, termed the MELD score, was tested in populations of cirrhotic patients for assessing early (3 months) mortality risk after placement on the waiting list.[28] This modified score proved to be a robust marker of early mortality which could be generalized to patients with various causes of cirrhosis and various degrees of severity. Excluding the variable “cause of cirrhosis” had a minimal impact on the model accuracy. As a result, a simplified version of MELD score including only three objective variables (bilirubin, creatinine, and INR) was eventually proposed for easier use ( Table 3 ).[29] According to this modified score, patients with bilirubin and creatinine values below 1 mg/dL (17 and 90 μmol/L, respectively) are rounded off to 1 mg/dL to avoid negative logarithmic values. Similarly, patients with INR below 1 are rounded off to 1. Whatever the individual values, the score is empirically capped at 40. Consequently, MELD score represents a continuous variable ranging from 6 to 40.
Applications

MELD score has been adopted since 2002 for organ allocation to patients listed for liver transplantation in the United States.[30] According to the MELD-based policy, patients with the highest score have a priority for organ allocation. More recently, MELD score has also been adopted in several European countries as well as in South America. The impact of MELD score on liver transplantation is discussed below.

In addition to organ allocation, several studies have confirmed that MELD score is a reliable tool for predicting outcome after TIPS.[31,32] The “c” statistic represents a global estimate of the ability of a score to predict an event. This statistic, which is derived from the area under the receiver operating characteristic curve, ranges from 0 to 1. A “c” statistic of 0.5 means that the score is of no value for predicting a given event. A “c” statistic of 1 means that the score is perfect (a goal which is never achieved in clinical practice). The “c” statistic of the MELD score for predicting 1-year survival after TIPS is ∼0.7, which means that it is clinically useful. MELD score also proved to be a reliable marker of 1-year and 5-year survival across a broad spectrum of liver diseases including alcoholic cirrhosis and alcoholic hepatitis.[33] In addition, MELD score has been shown to be a good prognostic marker in cases of variceal bleeding,[34] spontaneous bacterial peritonitis,[35] and hepatorenal syndrome.[36] Independent of the cause of cirrhosis, high MELD score was shown to be associated with a decrease in residual liver function as measured by monoethylglycinexylidine test.[37] The particular issues of alcoholic cirrhosis, HCC, nontransplant surgery, and transplantation are detailed below.
Limitations

Using statistical analysis rather than empirical selection of variables for establishing a prognostic score can be anticipated as more rigorous, on a methodological basis, and eventually, more efficacious. However, it must be kept in mind that even if the three components of the MELD score have been selected on the basis of a statistical analysis, all the variables entered in the model have been empirically selected, because they were felt to have an influence on the outcome or, more simply, because they were available. It cannot be excluded that other important variables may not have been taken into account.

The three variables entered in the MELD score (bilirubin, creatinine, and INR) are supposed to be objective (in contrast to ascites and encephalopathy, the grading of which is subjective). However, even these “objective” markers may be subjected to significant variations resulting from either changes over time or from different laboratory methodologies. There are substantial interlaboratory variations in INR depending on the methods used for determination. It has been shown that interlaboratory variation in INR is ∼25%. Among the three variables of MELD score, INR has the highest multiplicative value. Therefore variations in INR may translate to up to 20% differences in MELD score.[38] In single individuals with cirrhosis, substantial changes in serum creatinine may occur, especially in those undergoing large-volume paracentesis and/or receiving diuretics. Laboratory methods may also interfere with the value of serum creatinine. There is a poor agreement among different creatinine assays, especially as serum bilirubin rises.[39] Overall, MELD score is not as objective as it was expected to be.

A major limitation of MELD score is the need for computation, which makes it less friendly to use than Child-Pugh score at the bedside. Logarithmic transformation has been chosen to optimize the statistical model. Originally, this statistical model and the derived score were not designed to be routinely used in clinical practice. With the expansion of MELD score in many fields of hepatology, the need for computation represents a source of difficulties. There is no evidence that a simplified score based on the original values of bilirubin, INR, and creatinine (without logarithmic transformation) would be less accurate. In addition, there are no clear-cut values of MELD score for easily categorizing individual patients according to their own mortality risk.

From:  Assessment of Prognosis of Cirrhosis
Posted 04/28/2008
François Durand, M.D.; Dominique Valla, M.D.
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Avatar_m_tn
You're welcome Elaine. Mike
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338734_tn?1377163768
That article looks like it doesn't change much for the present system, but explores where some improvements and gains might cme from in the future. Of particular interest to me was the use of MELD score for HCC patients. Since my tumor was benign, it appears that I took greater risk with the surgery and possible could a have treated at that point since my liver was at least partially comensated. Could have been a dicey decision, a crazy decision based on the HCC diagnosis. Anyway, I am not sorry for the outcome. I think there were a lot of benefits before I reached a place where I was hospitalized before transplant.

I understand the system and its strengths and weaknesses better now. Thanks again for the up-to-date data.

Brent
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Mike:  Thanks for the article!  I'm trying to understand the whole MELD scoring system as well as trying to learn about the process leading to transplant.  Every bit of info helps, but I still don't quite get how the HCC component plays into the MELD score (or does it?)

Walrus:   I'm very curious (if you don't mind) as to the circumstances that led to your transplant... was it immediately pursued at the time of tumor diagnosis?  Was it your MELD score that put you on the transplant list, or the presence of tumor, or both?  My husband has well-compensated cirrhosis, but he had liver resection for a tumor that was HCC last year.  His CT scan 2 weeks ago showed a couple of echogenic spots -- doc said could be nothing, could be the start of HCC -- so I'm trying to arm myself with as much knowledge as I can before the next CT Scan in August.  (I've heard that if there are more than 2 tumors, it disqualifies one for transplant... is that true?)

Thanks for any input.
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I don't know precisely how HCC is factored in but I do know that it bumps you up the list. I believe most centers follow that Milan criteria - transplant is considered when a patient has one nodule less than 5 cm or 3 or less nodules and none larger than 3 cm. I think that's right but without checking I can't be sure. Mike
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So... if a patient has cirrhosis and a low MELD score... would the occurrence of HCC make him a candidate for transplant?  Or does the MELD score have to reach a minimum value before consideration for transplant?  (At what MELD score is someone eligible to be on the transplant list?)

Thanks for your input.
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thanks for posting this. Of course, how one would convince a doctor Meld might not be accurate becomes the next question.
Still, it's good to know ones misgivings may have basis.I'm fairly certain my Meld does not reflect my true stage and state, so  this is at least a starting point now.
appreciate it.
mb
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419309_tn?1326506891
Thanks for your response and your kind words.  Hugs back!
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338734_tn?1377163768
The idea of additional MELD score points is to add additional points to the HCC patient's MELD score so that he would face an equivalent risk of mortality while waiting for transplant as other candidates. Without these additional points, an HCC patient would have little or no chance of surviving long enough to progress up the list (by MELD score) before his cancer spread (beyond the Milan criteria) and transplant would be of no help.

The results of my tests (biopsy and bloodwork) showed stage 4 cirrhosis and elevated AFP. This led the doctor to do CT scan and ultrasound which came back positive for a lesion that looked to be a 3 cm HCC nodule. Additional CT and MRI scans with different contrasts, etc. were done and came back with a diagnosis of HCC. I was sent to a surgeon for resection, but the surgeon said it was too risky because of the location of the lesion next to the IVC and also because of the advanced stage of cirrhosis. I was then referred to a transplant clinic.

I do not remember the actual value of my MELD score without additional HCC points at time of my transplant, but I believe it was around 15. I do not know if there is a minimum value for an HCC patient (or others) to qualify for transplant.

The best source that I have found for understanding the MELD system is on the Unos/OPTN website. See section 3.6 and particularly 3.6.4.4 about HCC.

http://www.unos.org/policiesandbylaws/policies.asp?fromPage=Policy
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The Milan criteria is exactly as Mike states to my knowledge, there can be up to 3 tumors. One additional point, a tumor must be at least 2 cm. I believe that radiological identification of these as tumors is difficult or unreliable if the size is less than 2 cm.

I hope that this helps you. I also hope that the spots on the liver are just that, not malignant.

Best of everything,
Brent

Please PM me anytime you want. I would be more than glad to be of assistance to you.

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338734_tn?1377163768
I think that the MELD sscore, like most of public policy medicine, is the best attempt to be able to make a uniform assessment across a very individualistic thing. Statistically, it seems to be the best tool available.

Of course, statistically speaking, a person with his head in an oven and his feet on ice could have an average body temperature that would be quite comfortable.  ;)

Brent
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Avatar_m_tn
From:
Assessment of Prognosis of Cirrhosis
Posted 04/28/2008
François Durand, M.D.; Dominique Valla, M.D.

See: http://www.medscape.com/viewarticle/572659_1

Limitations

Using statistical analysis rather than empirical selection of variables for establishing a prognostic score can be anticipated as more rigorous, on a methodological basis, and eventually, more efficacious. However, it must be kept in mind that even if the three components of the MELD score have been selected on the basis of a statistical analysis, all the variables entered in the model have been empirically selected, because they were felt to have an influence on the outcome or, more simply, because they were available. It cannot be excluded that other important variables may not have been taken into account.

The three variables entered in the MELD score (bilirubin, creatinine, and INR) are supposed to be objective (in contrast to ascites and encephalopathy, the grading of which is subjective). However, even these “objective” markers may be subjected to significant variations resulting from either changes over time or from different laboratory methodologies. There are substantial interlaboratory variations in INR depending on the methods used for determination. It has been shown that interlaboratory variation in INR is ∼25%. Among the three variables of MELD score, INR has the highest multiplicative value. Therefore variations in INR may translate to up to 20% differences in MELD score.[38] In single individuals with cirrhosis, substantial changes in serum creatinine may occur, especially in those undergoing large-volume paracentesis and/or receiving diuretics. Laboratory methods may also interfere with the value of serum creatinine. There is a poor agreement among different creatinine assays, especially as serum bilirubin rises.[39] Overall, MELD score is not as objective as it was expected to be.

A major limitation of MELD score is the need for computation, which makes it less friendly to use than Child-Pugh score at the bedside. Logarithmic transformation has been chosen to optimize the statistical model. Originally, this statistical model and the derived score were not designed to be routinely used in clinical practice. With the expansion of MELD score in many fields of hepatology, the need for computation represents a source of difficulties. There is no evidence that a simplified score based on the original values of bilirubin, INR, and creatinine (without logarithmic transformation) would be less accurate. In addition, there are no clear-cut values of MELD score for easily categorizing individual patients according to their own mortality risk.
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Avatar_m_tn
I apologize for posting the same information twice.
It's one of those days again - I seem to have a lot of them lately.
Mike
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Would you mind explaining MELD score down to the terms for the completely uninitiated?  IF possible.  I'd like to understand what someone says when they say their MELD score is this or that.  How does that translate to eligibility for transplant?

Thanks Mike / anyone.

Trish
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You know.. I just started reading that article again and I think I'll try again when I have a quieter moment and when I'm, um, not at work .. to read and comprehend it.  THEN I'll come back with any questions after I've had time to put a bit more effort into understanding it.  Thanks.

Trish
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419309_tn?1326506891
"Without these additional points, an HCC patient would have little or no chance of surviving long enough to progress up the list (by MELD score) before his cancer spread (beyond the Milan criteria) and transplant would be of no help."
----------------
That was what I was afraid of initially.  Many thanks for the clarification!  Does that mean, then, with the Milan criteria < or equal to 3, multi-centric HCC patients do not have the option of TP?  

On a lighter note:  I've seen your name around the forums a bit, and everytime I see it I smile because of the following:

http://sg.video.yahoo.com/video/play?vid=2202820

~eureka
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338734_tn?1377163768
No, no. It means the opposite! If the patient has  5 cm, then that patient will benefit from transplant and is elegible for transplant. In addition, they will have points added to their MELD score which will increase their priority on the list. With HCC, the less the better (in more ways than one).

Sorry if I misled you.
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338734_tn?1377163768
Had an editing problem in that last post. It should have been:

No, no. It means the opposite! If the patient has more than 3 tumors, he will be ineligible for TP. Likewise if a single tumor is larger than 5 cm he will also be ineligible. If the candidate has HCC, but the number and size do not exceed the criteria above, then the candidate is eligible for TP. In addition, they will have points added to their MELD score which will increase their priority on the list.

With HCC, the less the better (in more ways than one).

Sorry if I misled you
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LOL! Loved the dancing walrus!

Brent
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338734_tn?1377163768
I think I understand the MELD system and how it functions in organ distribution, but not the details of the chemistry or the statistacal analysis used to justify it. Mike's post addresses that pretty well and raises valid concerns about it's suitability.

I think the real details on how it is used are in the UNOS Policies found on their website (link posted earlier in thread).

Brent

Checkout Eureka's post for the Dancing Walrus. It gave me a chuckle!
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419309_tn?1326506891
You did not mislead at all!  Your explanation was excellent, and it did make sense to me... my translation and question phrasing was poor and unclear.  (I'm sure there's a logical reason that people with more than 3 HCC tumors are not considered for TP... I've been trying to get through the UNOS site... so many pages! ... but THANK YOU for pointing me there.  It's sure to answer a lot of my questions when I get to comb through it and absorb it a bit.)

Between yourself and mikesimon I have lots of great references on this thread alone :).
It's fantastic to be able to get technical and medical references and data as well as layman's translations and explanations!
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419309_tn?1326506891
Glad you liked the video ... from this point forward I'll think of you as
IAmTheDancingWalrus :).
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338734_tn?1377163768
You have apparently never seen me dance. The walrus would be offended by the comparison!

The part of the UNOS site that deals with this is a little hard to find. It is in the area for "Policy".

Good luck,
Brent
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You ask why a pt with more than 3 tumor is ineligible for TP. I'll venture my opinion based on the studies I've read.  It is because, at this point, it is considered likely that the cancer has or will spread and the potential benefit of TP will be negated by return of the cancer. Same thing with the tumor size. Why TP for a pt with 3 tumors @ 3 cm each but not for a pt with 4 tumors @ 2 cm each? I can't say exactly. TP in patients with HCC beyond these criteria are associated with poor outcomes.

Brent

P.S. Ever see Matt Lauer dance?  ;)
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Avatar_m_tn
From: Liver Transplantation: An Update
Posted 04/17/2006
    
     See:  http://www.medscape.com/viewarticle/528898_1


Hepatocellular Carcinoma and Liver Transplantation - Current Allocation Rules and Expansion of Criterion for Transplantation


".....The incidence of HCC and mortality is increasing in the USA as the hepatitis C epidemic of the 1970s and 1980s matures.[23] In patients with cirrhosis and HCC liver transplantation remains the best option for long-term survival. Using stringent selection criteria (often referred to as the Milan criteria), limiting transplantation to patients with a single nodule of less than 5 cm or up to three nodules with none bigger than 3 cm,[24] an actuarial 4-year survival rate of 75% and recurrence-free survival rate of 83% was achieved. Subsequent studies have confirmed the excellent survival after transplant for HCC meeting the Milan criteria.[25,26]

Under the UNOS system, the reliance on waiting time meant that many patients with HCC advanced beyond the Milan criteria while awaiting transplantation. One of the key elements in introduction of allocation based on MELD score was the recognition that an arbitrary priority score would be necessary for exceptional patients at risk of death from liver disease not identified by changes in serum bilirubin, creatinine or prothrombin time. HCC is the most common of these exceptions. An additional advantage of MELD is that it has facilitated adjustment of the exceptional attribution of points according to the effect of particular priority scores on donor liver allocation in practice. After a few initial modifications,[5] the current system does not attribute priority points to patients with stage 1 HCC, whereas stage 2 HCC is currently allocated 24 priority points. With these provisions, in the first year after MELD implementation, the number of patients with HCCs that were transplanted increased from 167 (7% of total transplants) to 408 (22%).[8*,27*] Waiting time to deceased-donor transplant for HCC patients decreased from a mean of 2.3 to 0.69 years. The 5-month dropout rates due to cancer progression also decreased from 25.9 to 6.7%.

As experience grows with transplantation for small HCC, individual centers have analyzed their data for transplantation of tumors exceeding the Milan criteria. Yao et al.[28] retrospectively analyzed the outcome of 70 patients with HCC undergoing transplantation. Those that on pathologic exam of the explant exceeded the Milan criteria but met expanded criteria (single lesion less than or equal to 6.5 cm, two or three nodules, with the largest less than or equal to 4.5 cm, and total tumor diameter 8 cm or less) had a 75% 5-year survival rate. Patients exceeding these criteria however had a 50% 1-year survival rate after transplant.

Even though these results are encouraging, these data were based on patients that met the Milan criteria radiographically even if they exceeded them pathologically. Prospective application of these expanded criteria to radiographically staged tumors has yet to be reported. In other studies, predictors of dropout from the waiting list have included a single lesion greater than 3 cm or three nodules. MELD allocation should be studied further to refine prioritization for HCC based on similar characteristics and different risks of dropout.[29] Further prospective study should be done for other potential predictors of HCC outcomes, including tumor grade, microvascular invasion and tumor markers......"

Mike
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I agree with you. The Milan Criteria and the Expanded Milan Criteria is an attempt to determine the likelihood of HCC recurrence which obviously and significantly affects the life expectancy of the patient. Some studies seem to demonstrate that the tumor size can be underestimated.
"Scan examinations in the preoperative evaluation underestimated about 42.2% of tumors. Those patients had vascular invasion but the survival after 10 years was similar between the ECM and MC groups".
see: http://www.ncbi.nlm.nih.gov/pubmed/18455014

Mike




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That is very interesting. Despite vascular invasion on the underestimated tumors, the survival rates are not that much different, 47.4% vs. 57.7% at 10 years. Use of exceptional points to the MELD score has certainly benefited HCC patients greatly in reduced mortality due to cancer progression.

Brent
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My husband has HCC, cirrhosis, 4 tumors,Hep C, esophageal and rectum varicies and is a diabetic.  He is on the transplant list and has been since October.  He is in great health for his stage. His hepatologist said he needed a liver in 2/3 months.  She said he can not wait 6 months.  I have done the MELD calculations on the UNOS site I get a score of 10 and on another I get 6. At that score he will never get a liver until it spreads!  Can anyone give me more answers.
Thanks,
Vickie
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Avatar_f_tn
Hi Vickie,

Hi Vickie,
Having HCC should boost him up the list
I believe they factor in points for his MELD having HCC.

In addition, get listed where ever you can, you can get
listed in different regions and/or states if his health allows
travel.

Good Luck to you both, I wish you the very best.
Hugs
Elaine
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Elaine is correct. I will post 2 abstracts which touches on this subject. With HCC a high MELD score is predicter a poor post transplant survival so it is fortunate that your Husband's score isn't really high. There is a Milan Criteria and an Expanded Milan Criteria which are set forth criteria for transplants with HCC patients. I do not know precisely what the criteria are but I recall that 3 or more tumors greater than 3.5 cm can discourage some centers from transplanting - or a single tumor greater than 5 cm. I could be wrong about this so Google "Milan Criteria" to be sure. The Expanded Milan Criteria allows greater tumor size and perhaps number. I would assume that since your Husband is listed he much meet one of these criteria.
The system by which bonus points are awarded to HCC patients is confusing to me. It appears as though the predicted mortality is the key factor and AFP may play an important role too. I haven't really researched this lately so I am basically trying to remember this stuff.
I think you should see your Husband's hepatologist and ask your questions. We never want to be adversarial but, at times, we must be forceful and direct. You have a right to know the manner in which he is being evaluated and what you can expect. No one can tell you when, or whether, he'll get a liver but they give their opinion of the likelihood and approximately what his position is on the list. Size and blood type are other factors which have to be considered but you deserve to have a better understanding of your Husband's situation. So be forceful and find out what you need to know. I know you are in an extremely difficult and heart wrenching situation but I think action does a lot more to allay anxiety than inaction. And you might get better results too.
Good luck Vickie.
Mike

2009 Dec;13(12):2268-75. Epub 2009 Aug 7.
Perioperative Risk Assessment for Hepatocellular Carcinoma by Using the MELD Score.

Delis SG, Bakoyiannis A, Dervenis C, Tassopoulos N.

Division of Liver and GI Transplantation, University of Miami Miller School of Medicine, Miami, FL, 33136, USA, ***@****.

BACKGROUND/AIMS: The aim of this study was to evaluate the ability of Model for End-Stage Liver Disease (MELD) in predicting post hepatectomy outcome for hepatocellular carcinoma (HCC). METHODS: Between 2001 and 2005, 94 cirrhotic patients with HCC underwent hepatectomy and were analyzed retrospectively. MELD score associated with postoperative mortality and morbidity, hospital stay, and 3-year survival. RESULTS: Twenty-eight major and 66 minor resections were performed. Thirty-day mortality rate was 6.4%. MELD  9 (p = 0.01). Overall morbidity rate was 32%; 21% when MELD  9 (p = 0.01). Median hospital stay was 11 days (7 days, when MELD  9; p = 0.03). Three-year survival reached 48% (63% when MELD  9; p  9 (p = 0.01), clinical tumor symptoms (p = 0.04), and American Society of Anesthesiologists score (p = 0.04) were independent predictors of perioperative mortality; MELD > 9 (p = 0.01), tumor size >5 cm (p = 0.01), presence of tumor symptoms (p = 0.02), high tumor grade (p = 0.01), and absence of tumor capsule (p = 0.01) were independent predictors of decreased long-term survival. CONCLUSION: MELD score seems to predict outcome of cirrhotic patients with HCC after hepatectomy.

PMID: 19662460 [PubMed - in process]

Pre-transplant therapy for hepatocellular carcinoma is associated with a lower recurrence after liver transplantation.

Lao OB, Weissman J, Perkins JD.
Department of Surgery, University of Washington, Seattle, WA, USA.

Lao OB, Weissman J, Perkins JD. Pre-transplant therapy for hepatocellular carcinoma is associated with a lower recurrence after liver transplantation. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.00993.x (c) 2009 John Wiley & Sons A/S.Abstract: Background: Hepatic transplantation has been advocated as an effective treatment for hepatocellular carcinoma (HCC). We seek to determine if pre-transplant therapies can reduce post-transplant recurrence. Methods: We conducted a retrospective review of prospective data in patients undergoing transplantation for HCC 2001-2006. Patients were followed for recurrence every six months with abdominal computerized tomography or magnetic resonance imaging. Logistic regression analyzed recipient factors such as prior treatment for HCC, donor, operative, and tumor factors in comparing patients developing HCC recurrence with those without recurrence. Results: During the study period, we performed 124 hepatic transplants for HCC [age: 55 +/- 7.6 yr; 104 (85%) male, 81 (66%) white, and 32 (26%) Asian]. Recurrence was found in nine at a mean of 2.6 yr follow-up. Thirty-three patients (27%) had pre-transplant treatment (radiofrequency ablation, transarterial chemoembolization or percutaneous ethanol injection). Univariable logistic regression identified nine factors [body mass index, Asian race, hepatitis B, prior HCC therapy, alpha-fetoprotein (AFP), model for end-stage liver disease (MELD) score, bilirubin, and international normalized ratio] predictive of HCC recurrence at a level of p 1000, calculated pre-transplant MELD score <14, and the lack of any pre-transplant treatment were significantly associated with recurrence of HCC. No patient with prior HCC therapy had recurrence. Conclusions: In patients with HCC awaiting hepatic transplantation, there is a reduced rate of recurrence of HCC if tumors are pre-treated with liver-directed therapy. By treating HCC tumors with any type of treatment prior to transplant, we can significantly reduce the odds of HCC recurrence after transplant.
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My husband had a liver transplant in Aug. 2008 due to a suspicious lesion.  His liver was cirrhotic due to Hepatitis C.  His MELD score would have been somewhere in the area of 3 if I calculate correctly using his test scores and he was not sick at all, but we were told that the diagnosis of cancer immediately gave him 22 points.  That was not added to whatever his MELD score would have been.  He just started out with 22.  After each 3-month waiting period 3 more points are added to the MELD score.  We were told to expect to wait about 6 months.  It turned out to be just 6 days before he received a new liver.

Have you husband's doctors talked about TACE or chemoembolization to reduce and/or possibly totally destroy any of the tumors while he waits?  I hope that he receives a liver very soon.
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