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Eric T. Castaldo, MD, MPH; Irene D. Feurer, PhD; Robert T. Russell, MD, MPH; C. Wright Pinson, MD, MBA

Arch Surg. 2009;144(2):167-172.

Objective  To determine whether a correlation exists between the Model for End-Stage Liver Disease (MELD) score and health-related quality of life (HRQOL) after liver transplant (LT).

Design  Prospective cohort.

Setting  University hospital.

Patients  Adult LT recipients (N = 209).

Main Outcome Measures  Postoperative HRQOL over a 1-year period after LT as measured via multiple regression–based path analysis testing the effects of the MELD score, preoperative variables, and postoperative variables on scores on the physical component summary and mental component summary scales of the 36-Item Short Form Health Survey and on composite physical and mental HRQOL scores derived from multiple scales.

Results  The MELD score (β = .16), cholestatic cirrhosis (β = .12), autoimmune/metabolic disease (β = .18), neoplasm (β = .23), time after LT (β = .16), and the Karnofsky score (β = .49) had significant effects on the physical component summary scale score. Autoimmune/metabolic disease (β = .16) and the Karnofsky score (β = .25) had significant effects on the mental component summary scale score. The MELD score (β = .15), high school education (β = .15), college education (β = .17), autoimmune/metabolic disease (β = .15), neoplasm (β = .23), time after LT (β = .11), and the Karnofsky score (β = .51) had significant effects on the composite physical HRQOL score. Autoimmune/metabolic disease (β = .23), neoplasm (β = .15), and the Karnofsky score (β = .42) had significant effects on the composite mental HRQOL score.

Conclusions  An increasing MELD score, when computed without any diagnosis-based exception points, was associated with improved physical HRQOL in the first year after LT. The MELD score did not affect mental HRQOL.

Author Affiliations: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery (Drs Castaldo, Feurer, Russell, and Pinson) and Department of Biostatistics (Dr Feurer), Vanderbilt University Medical Center, Nashville, Tennessee.

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