Predicting clinical and economic outcomes after liver transplantation using the Mayo primary sclerosing cholangitis model and Child-Pugh score

Issues in the selection and timing of liver transplantation for primary scl erosing cholangitis (PSC) remain controversial. Although the Child-Pugh cla ssification (CP) score and Mayo PSC model have similar abilities to estimat e pretransplantation survival, a comparison of these 2 scores in predicting survival after liver transplantation has not been conducted. The aim of th is study is to compare the Mayo PSC model and CP score in predicting patien t survival and related economic outcomes after liver transplantation. Data from 128 patients with PSC, identified from the NIDDK database, were used t o calculate patient-specific Mayo PSC and CP scores before transplantation. Levels reflecting a poor outcome were defined a priori. Receiver operating characteristic (ROC) curves and regression methods (Cox proportional hazar ds and linear regression models) were used to assess the relationship betwe en these 2 scores and 5 post liver transplantation outcome measures. CP sco re was found to be a significantly (P < .05) better predictor of death 4 mo nths or less after liver transplantation than: (a) length of hospital stay >21 days (or death before discharge) and (b) resource utilization >200,000 units (measured by area under the ROC curve). The Cox model identified stat istically significant (P < .05) associations between CP score and each outc ome after adjusting for the Mayo PSC risk score. Similar results were not o bserved for the Mayo PSC model when adjusted for CP score. Among patients w ith PSC undergoing liver transplantation, CP score was a better overall pre dictor of both survival and economic resource utilization compared with the Mayo PSC model.