Refitting the Model for End‐Stage Liver Disease for the Eurotransplant Region

Abstract

BackgroundThe UNOS-MELD score is the basis of liver allocation in the Eurotransplant region. It was constructed 20 years ago in a small US cohort and has remained unchanged ever since. The best boundaries and coefficients were never calculated for any region outside the US. Therefore, this study refits MELD (reMELD) for the Eurotransplant region. MethodsAll adult patients listed for a first LT between 01.01.2007-31.12.2018 were included. Data was randomly split in a training (70%) and validation (30%) set. In the training data, generalized additive models (GAMs) with splines were plotted for each MELD parameter. The lower and upper bound combinations with the maximum log-likelihood were chosen for the final models. The refit models were tested in the validation data with c-indices and Brier scores. Through likelihood ratio tests the refit models were compared to UNOS-MELD. The correlation between scores and survival of prioritized patients was calculated. ResultsA total of 6,684 patients were included. Based on training data, refit parameters were capped at creatinine 0.7-2.5, bilirubin 0.3-27, INR 0.1-2.6 and sodium 120-139. ReMELD and reMELD-Na showed c-indices of 0.866 and 0.869 respectively. ReMELD-Na prioritized patients with 1.6 times higher 90-day mortality probabilities as compared to UNOS-MELD. ConclusionRefitting MELD resulted in new lower and upper bounds for each parameter. The predictive power of reMELD-Na was significantly higher than UNOS-MELD. ReMELD prioritized patients with higher 90-day mortality rates. Thus, reMELD(-Na) should replace UNOS-MELD for liver graft allocation in the Eurotransplant region.

Joint modeling of liver transplant candidates outperforms the model for end-stage liver disease: The effect of disease development over time on patient outcome

“…Alcohol (30.5%)-and NASH (20.7%)-related cirrhosis were most common. The median MELD at listing was 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), which was higher than the MELD 15 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) for the Eurotransplant region. Median MELD-Na at listing was 19 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) points in the UNOS cohort.…”

“…The median MELD at listing was 18 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), which was higher than the MELD 15 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) for the Eurotransplant region. Median MELD-Na at listing was 19 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) points in the UNOS cohort. At the end of follow-up, 52.2% was transplanted, 13% had died while waiting or was removed because of worsening clinical condition, 31% was removed due to improved condition, exception point, or status 1 approval during follow-up, and 3.8% was censored at the end of study.…”

Development and validation of a dynamic survival prediction model for patients with acute-on-chronic liver failure

“…the sickest patients die or are transplanted first and less patients remain with increasing follow-up. 21 Also, with increasing disease severity, generally a shorter follow-up period is available. The ACLF-JM approximation of disease does not depend on the number of measurements per patient, because it estimates disease over time as a continuous trajectory ( Fig.…”

A novel radiomics signature based on T2-weighted imaging accurately predicts hepatic inflammation in individuals with biopsy-proven nonalcoholic fatty liver disease: a derivation and independent validation study

“…According to a ratio of 7:3 (27), 91 subjects from the Wenzhou cohort were randomly assigned to the training set. Their mean age was 43.1±12.5 years and they were predominantly men (72.5%).…”