Predicting Survival after Liver Transplantation Based on Pre-Transplant MELD Score: a Systematic Review of the Literature

Abstract

The model for end-stage liver disease (MELD) score is used to stratify candidates for liver transplantation based on objective measures of disease severity. MELD has been validated as a predictor of wait-list mortality in transplantation candidates and has been postulated as a predictor of post-transplant survival. The purpose of this study was to examine the predictive value of the pre-transplantation MELD score on post-transplant survival from relevant existing studies. A systematic review and critical appraisal was performed using Cochrane guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were searched for articles published in the English language since 2005 using a structured search strategy. There were 3058 discrete citations identified and screened for possible inclusion. Any study examining the relationship between pre-transplant MELD and post-transplant survival in the general transplant population was included. Thirty-seven studies met these criteria and were included in the review. Studies were all case series that typically involved stratified analyses of survival by MELD. They represented 15 countries and a total of 53,691 patients. There was significant clinical heterogeneity in patient populations across studies, which precluded performance of a meta-analysis. In 15 studies, no statistically significant association between MELD and post-transplant survival was found. In the remaining 22, some association was found. Eleven studies also measured predictive ability with c-statistics. Values were below 0.7 in all but two studies, suggesting poor predictive value. In summary, while the majority of studies reported an association between pre-transplantation MELD score and post-transplant survival, they represented a low level of evidence. Therefore, their findings should be interpreted conservatively.

Living Donor Liver Transplant Versus Cadaveric Liver Transplant Survival in Relation to Model for End-Stage Liver Disease Score

“…When stratifying patients in relation to MELD score (>25 and <25, respectively), there was also no difference in survival, either short-or long-term. In agreement with our data, a recent systematic review concluded that the use of pre-transplant MELD does not serve as a reliable predictor of posttransplantation survival [12]. In another paper, 145 LDLT were matched 1:1 with DDLT, and there was no difference in survival rates between the groups; they had 8 patients in each arm with MELD>25 [13].…”

Early post-transplant survival: Interaction of MELD score and hospitalization status

“…Several studies have evaluated the ability of the MELD score to predict post-transplant mortality with mixed results 2–5 . In Europe, a number of previous studies demonstrated an increase in post-transplant mortality after adoption of the MELD-based allocation system – a change that closely correlated with transplanting candidates with higher MELD scores.…”

National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

“…Debate, however, still exists about the pretransplant MELD score's capacity to predict posttransplant outcome (12), particularly because the MELD score was designed to predict pretransplant mortality. Although the MELD score may not be a good discriminator of outcome in the 21-34 range (13), it is clear that patients with MELD scores ≥35 have inferior patient and graft survival outcomes compared with those with a score of ≤20.…”