Impact of MELD Allocation System on Waiting List and Early Post-Liver Transplant Mortality

Abstract

Background and aimsMELD allocation system has changed the clinical consequences on waiting list (WL) for LT, but its impact on mortality has been seldom studied. We aimed to assess the ability of MELD and other prognostic scores to predict mortality after LT.Methods301 consecutive patients enlisted for LT were included, and prioritized within WL by using the MELD-score according to: hepatic insufficiency (HI), refractory ascites (RA) and hepatocellular carcinoma (HCC). The analysis was performed to predict early mortality after LT (8 weeks).ResultsPatients were enlisted as HI (44.9%), RA (19.3%) and HCC (35.9%). The major aetiologies of liver disease were HCV (45.5%). Ninety-four patients (31.3%) were excluded from WL, with no differences among the three groups (p = 0.23). The remaining 207 patients (68.7%) underwent LT, being HI the most frequent indication (42.5%). HI patients had the shortest length within WL (113.6 days vs 215.8 and 308.9 respectively; p<0.001), but the highest early post-LT mortality rates (18.2% vs 6.8% and 6.7% respectively; p<0.001). The independent predictors of early post-LT mortality in the HI group were higher bilirubin (OR = 1.08; p = 0.038), increased iMELD (OR = 1.06; p = 0.046) and non-alcoholic cirrhosis (OR = 4.13; p = 0.017). Among the prognostic scores the iMELD had the best predictive accuracy (AUC = 0.66), which was strengthened in non-alcoholic cirrhosis (AUC = 0.77).ConclusionPatients enlisted due to HI had the highest early post-LT mortality rates despite of the shortest length within WL. The iMELD had the best accuracy to predict early post-LT mortality in patients with HI, and thus it may benefit the WL management.

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

“…In a retrospective cohort of 301 patients with TIPS and 451 patients awaiting LT, iMELD demonstrated its superiority by improving AUROC by 13.4 and 8% in the respective groups. In a study published in 2016, 26 the iMELD score showed superiority in predicting posttransplant mortality in patients enrolled for liver failure compared with MELD, MELD-Na, and UK End-Stage Liver Disease (UKELD) scores.…”

Fast‐Track Liver Transplantation: Six‐year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS) Protocol

“…The main outcome measures were length of hospital stay and survival. We monitored our results and compared them with those of similar centers across Spain [ 6 ] and elsewhere.…”

Impact of Model for End-Stage Liver Disease allocation system on outcomes of deceased donor liver transplantation: A single-center experience

“…This is because a patient's MELD score better reflects the waiting mortality rate than the CTP score. The MELD system succeeded in reducing the waiting list mortality in several countries [2,3,11]. Still, it is a controversial conclusion whether it can improve the long-term survival rate of liver transplant recipients.…”