Background: Decision of necessity of urgent liver transplantation for acute flare up of hepatitis B in the patients without cirrhosis is difficult. The MELD score indicators of urgent liver transplantation for these patients were set up in our department: MELD ≥35 or MELD <35 but increased in a subsequent week when total bilirubin level ≥17.5mg/dl. This study was to examine the validation of this MELD score criteria.

Patients: From 2008 to 2014, 83 non-cirrhotic hepatitis B patients having acute flare up of hepatitis B with total bilirubin level ≥17.5mg/dl were included in this study. The patients were divided into 3 groups: group 1, MELD ≥35; group 2, MELD <35 but increased in a subsequent week; and group 3, MELD <35 and deceased in a subsequent week. The prognosis among these 3 groups was compared.

Results: Among 83 patients, 20 patients were in group 1. Five of them were transplanted and the other 15 patients died of liver failure. The median (interquartile) listing time was 17 (13-24) days. Fifty-one patients were in group 2. Nineteen patients were transplanted, 30 patients died of liver failure and 2 patients recovered. Twelve patients were in group 3. All the patients recovered from acute stage, but 5 patients became Child C cirrhotic patients and listed for liver transplantation. The sensitivity of this MELD score criteria for urgent liver transplantation in hepatitis B patients with acute flare up was 100% and specificity was 85.7%. The 1-, 2- and 3-year survival for the patients with transplantation was 81.2%, 74.4% and 74.4%, respectively. For the patients without liver transplantation, 1-, 2- and 3 month survival rates were 28.3%, 8.7% and 4.4%, respectively.

Conclusion: MELD score criteria are valid to determine the necessity of urgent liver transplantation for hepatitis B patients with acute flare up in non-cirrhotic livers.

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