Model for end-stage liver disease (MELD) and allocation of donor livers

Wiesner, Russell H.; Edwards, Erik; Freeman, Richard B.; Harper, Ann; Kim, Woojin; Kamath, Patrick S.; Kremers, Walter K.; Lake, John R.; Howard, Todd K.; Merion, Robert M.; Wolfe, Robert A.; Krom, Ruud A.F.; Colombani, Paul M.; Cottingham, Paige C.; Dunn, Stephen P.; Fung, John J.; Hanto, Douglas W.; McDiarmid, Sue V.; Rabkin, John M.; Teperman, Lewis; Turcotte, Jeremiah G.; Wegman, Lynn Rothberg

doi:10.1053/gast.2003.50016

Cited by 2,222 publications

(1,636 citation statements)

References 9 publications

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“…Data collected regarding the initial hospitalization and readmission included demographic characteristics, cause of cirrhosis, length of hospital stay, comorbidities, laboratory values (at admission and discharge dates), standardized costs, and the primary reason for admission. The MELD score and the MELD plus serum sodium (MELD‐Na) score were calculated within 48 hours of admission and within 48 hours before hospital discharge by applying standard formulas 8, 9, 10…”

Section: Methodsmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

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Section: Methodsmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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“…7 This trend continued in later years with reduction in total number of deaths on waitlist from 2046 in 2001 to 1364 in 2005 with reduction in waiting time from 656 days to 416 days. 27 Part of this reduction was due to increase in number of donor livers from 4671 in 2001 to 5160 in 2005.…”

Section: Impact On Outcomesmentioning

confidence: 96%

“…4 The model was later shown to quite accurately predict 3 months mortality amongst patients with chronic end-stage liver disease awaiting LT. 5,6 As the score was objective and could predict mortality at 3 months with higher accuracy than the CTP score, allocation of livers for transplantation became MELD based, deemphasizing the concept of waiting time. 3,7 The score was initially named as Mayo model for endstage liver disease (MELD) score reflecting the institution where the score was developed. With the acceptance of this score by the UNOS for organ allocation, the model was renamed as model for end-stage liver disease.…”

Section: Development Of the Model For End-stage Liver Disease Score Amentioning

confidence: 99%

“…This allowed wider acceptability of the score keeping the same abbreviation of MELD. 7,8 Other changes made to the score by the UNOS were: capping serum creatinine at 4 mg/dl, capping the score at 40, and setting the lower limit for each component of the score to 1 in order to avoid negative scores. Further, etiology of the liver disease as a factor was removed from the model, as this did not impact mortality amongst patients with end-stage liver disease awaiting LT. 5 …”

Section: Development Of the Model For End-stage Liver Disease Score Amentioning

confidence: 99%

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Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

125

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“…Since the implementation of the Model for End-Stage Liver Disease (MELD) scoring system in February 2002, organs are allocated to the sickest patients in a geographic area, 1,2 and OLT is increasingly performed on high-acuity patients, who are at greater risk of postoperative complications because of the severity of their liver disease. 2,3 Complications such as bleeding, biliary or vascular compromise, and intra-abdominal infection can require urgent reoperation to prevent early graft loss, long-term graft dysfunction, or mortality. 4,5 Although the general surgery literature indicates that relaparotomy increases mortality, 6-8 data about reoperative complications after OLT are limited.…”

mentioning

confidence: 99%

Reoperative Complications after Primary Orthotopic Liver Transplantation: A Contemporary Single-Center Experience in the Post–Model for End-Stage Liver Disease Era

DiNorcia

Lee

Harlander-Locke

et al. 2014

Journal of the American College of Surgeons

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BACKGROUND: Data on complications requiring reoperation after orthotopic liver transplantation (OLT) are limited. We sought to describe the spectrum of reoperative complications after OLT, evaluate the associations with graft and patient survival, and identify predictors of need for reoperation. STUDY DESIGN: We retrospectively studied adult patients who underwent primary OLT at our institution from February 2002 to July 2012. The primary outcomes included occurrence of a reoperative complication. Secondary outcomes were graft and patient survival. Multivariable logistic regression analysis was used to model the associations of recipient, donor, and operative variables with reoperation.

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Model for end-stage liver disease (MELD) and allocation of donor livers

Cited by 2,222 publications

References 9 publications

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Model for End-stage Liver Disease

Reoperative Complications after Primary Orthotopic Liver Transplantation: A Contemporary Single-Center Experience in the Post–Model for End-Stage Liver Disease Era

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