Usefulness of CTP score and MELD score in listing patients for liver transplantation.

Murali, R (2010) Usefulness of CTP score and MELD score in listing patients for liver transplantation. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Liver transplantation is the only definite treatment modality for patients with end-stage liver cirrhosis. A major function of the predictive model is to accurately assess the probability of mortality within a given time interval, so that a timely liver transplantation can be performed. The Child score, which was first proposed in the 1960s and then modified as the Child-Turcotte-Pugh (CTP) score. The selection of predictors and construction of the CTP system were empirical, and the system contains parameters that were felt very important to affect the outcome. Although never formally validated as a prognostic tool, the CTP score is useful to assess the relative risk of mortality in patients with cirrhosis and has been popular for the past 3 decades. However, a major defect of the CTP system is a relatively narrow score range from 5 to 15. While the waiting list of liver transplantation is rapidly growing and patients on the waiting list far out number the cadaveric liver donors, the priority of patients with the same CTP score awaiting transplantation becomes difficult to judge. A simple first-come, first-served principle was proposed and used in the transplantation society [1]. However, investigators subsequently found that patients with a longer waiting time may actually have a less severe degree of cirrhosis. It was later demonstrated that waiting time is not a factor that affects survival and was abandoned as a criterion in organ allocation. Another potential inherent flaw of the CTP system is that it contains subjective variables, including the severity of encephalopathy and ascites, which may be greatly influenced by personal judgment from center to center during status interpretation. These drawbacks compromise the fairness of organ allocation in liver transplantation. AIM : The main aim of this prospective study was to compare the accuracy of the Child-Pugh score and the MELD score for the prediction of 3 month and 6 month survival in cirrhotic patients waiting for liver transplantation. CONCLUSION : The present study highlights the following, • The prognostication based on Child Pugh and MELD scores had almost identical discriminative ability for predicting 3Month (0.73 vs. 0.73) survival in patients on Transplant Waiting list. • The MELD score was better in predicting 6 month (0.82 vs. 0.73) survival when compared with CTP score. • A cut off point of 8.5 CTP score has been found optimal to predict sensitivity of 73.9% and specificity of 79.5%. • A cut off point of 15.5 for the MELD score has been found optimal to predict Sensitivity of 82.6% and specificity of 78%. In the setting of Liver transplant, the MELD may score better over the CTP score in determination of priorities for organ allocation.

Item Type: Thesis (Masters)
Uncontrolled Keywords: liver transplantation ; CTP score ; MELD score ; listing patients.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:18
Last Modified: 13 Jul 2017 04:18
URI: http://repository-tnmgrmu.ac.in/id/eprint/1582

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