Model for End-Stage Liver Disease (MELD) Score Does Not Predict Outcomes of Hepatitis B–Induced Acute-on-Chronic Liver Failure in Transplant Recipients

Abstract Background Acute-on-chronic liver failure (ACLF) is a severe clinical entity and liver transplantation is the only definitive therapy to salvage these patients. However, the timing of liver transplant for these patients remains unclear. Methods Seventy-eight patients undergoing liver transplantation because of hepatitis B ACLF were retrospectively analyzed from June 2004 to December 2010. The areas under the receiver operating characteristic curve (AUC) of Model for End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) score for the post-transplantation outcomes were calculated. Results The median age was 44 years (range, 25–64 years), serum bilirubin 418.53 μmol/L (range, 112.90–971.40 μmol/L), INR 3.177 (range, 1.470–9.850), and creatinine 70.84 μmol/L (range, 12.39–844.1 μmol/L); the median MELD score was 32 (range, 21–53) and CTP score 12 (8–15). The AUCs of MELD and CTP scores for 3-month mortality were 0.581 (95% confidence interval [CI], 0.421–0.742; sensitivity, 87.5%; specificity, 32.8%) and 0.547 (95% CI, 0.401–0.693; sensitivity, 75%; specificity, 41%), respectively. Meanwhile, there were no significant differences in hospital mortality ( P  = .252) or morbidity ( P  = .338) between the patients with MELD score ≥30 and those  Conclusions MELD score had no predictive ability for the outcomes of patients with hepatitis B ACLF after orthotopic liver transplantation.