Pretransplant MELD Score As a Predictor of Outcome After Liver Transplantation for Chronic Hepatitis C

Onaca, Nicholas; Levy, Marlon F.; Netto, George J.; Thomas, Mark J.; Sanchez, Edmund Q.; Chinnakotla, Srinath; Fasola, Carlos G.; Weinstein, Jeffrey; Murray, Natalie; Goldstein, Robert M.; Klintmalm, Göran B.

doi:10.1034/j.1600-6143.2003.00092.x

Cited by 63 publications

(45 citation statements)

References 19 publications

(13 reference statements)

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“…In a single center study, Saab et al (9) showed that patients with pretransplant MELD scores above 36 had a hazard ratio of 3.9 for posttransplant death compared to patients with MELD scores 36 and below. In a separate single center experience, Onaca et al (10,11) showed a statistical difference in a 2-year survival after transplant in patients with pretransplant MELD scores above 25. This difference was only shown to be significant in patients with hepatitis C and noncholestatic liver diseases.…”

Section: Discussionmentioning

confidence: 99%

“…The performance of the MELD score in predicting posttransplant survival has been more variable (9)(10)(11)(12)(13) but it is generally accepted that patients with very high MELD scores prior to transplant have worse outcomes than those with lower MELDs. With discussion of incorporation of the delta-MELD into organ allocation systems, the question of whether patients with high pretransplant delta-MELD scores have worse posttransplant outcomes would be critical in determining if this change in allocation system would increase posttransplant death rates.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

Berg

2004

American Journal of Transplantation

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Changes in model for end-stage liver disease (MELD) score of ≥5 points over 30 days (delta-MELD) is an independent predictor for death in patients awaiting liver transplantation. The aim of the current study was to determine if a positive change in MELD score occurring over the 30 days immediately prior to liver transplantation was predictive of posttransplant mortality. MELD scores from the day of transplantation and 30 days prior to transplantation were calculated for 1510 UNOS patients and used to compute a delta-MELD score. Multivariate modeling determined predictors of posttransplant mortality. Patients with a preoperative delta-MELD ≥ 5 had higher absolute MELD scores at transplant, shorter mean posttransplant survival and higher mortality. However, multivariate analysis showed that none of the excess mortality was attributable to the high delta-MELD score (p = 0.43 for delta-MELD ≥ 5) and the majority of the excess risk was attributable to absolute MELD score (p < 0.001) at the time of transplantation. Mortality of patients with rapidly worsening chronic liver disease who undergo transplantation depends substantially on absolute MELD score at the time of transplantation but not the rate of change immediately preceding transplant. Allocation policymakers should consider that a high delta-MELD in the immediate pretransplant period does not indicate greater posttransplant mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

Berg

2004

American Journal of Transplantation

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“…The post-LT mortality was high in our cohort. Significant predictors of post-LT mortality included previously reported factors among the overall recipient population, and donor factors (older donor, prolonged cold ischemia time, and cause of donor death other than head trauma, stroke, or anoxia) (26)(27)(28)(29). These three donor factors are components of the donor risk index (29).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

Sharma

Goodrich

Zhang

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Candidates with AKI including hepatorenal syndrome often recover renal function after successful liver transplantation (LT). This study examined the incidence and risk factors associated with renal nonrecovery within 6 months of LT alone among those receiving acute renal replacement therapy (RRT) before LT.Design, setting, participants, & measurements Scientific Registry of Transplant Recipients data were linked with Centers for Medicare and Medicaid Services ESRD data for 2112 adult deceased-donor LT-alone recipients who received acute RRT for #90 days before LT (February 28, 2002 to August 31, 2010. Primary outcome was renal nonrecovery (post-LT ESRD), defined as transition to chronic dialysis or waitlisting or receipt of kidney transplant within 6 months of LT. Cumulative incidence of renal nonrecovery was calculated using competing risk analysis. Cox regression identified recipient and donor predictors of renal nonrecovery.Results The cumulative incidence of renal nonrecovery after LT alone among those receiving the pre-LT acute RRT was 8.9%. Adjusted renal nonrecovery risk increased by 3.6% per day of pre-LT RRT (P,0.001). Age at LT per 5 years (P=0.02), previous-LT (P=0.01), and pre-LT diabetes (P,0.001) were significant risk factors of renal nonrecovery. Twenty-one percent of recipients died within 6 months of LT. Duration of pretransplant RRT did not predict 6-month post-transplant mortality.Conclusions Among recipients on acute RRT before LT who survived after LT alone, the majority recovered their renal function within 6 months of LT. Longer pre-LT RRT duration, advanced age, diabetes, and re-LT were significantly associated with increased risk of renal nonrecovery.

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“…15 In contrast to the clear benefit of accurately estimating mortality on the waiting list, MELD has not been found to be as useful in predicting mortality following liver transplantation. [16][17][18][19] Mortality in the post transplantation period is related not only to the degree of liver dysfunction prior to transplantation, but to other factors, such as donor characteristics, experience of the transplantation team, and random postoperative complications which cannot be predicted. Moreover, patient selection by physicians will tend to negate the effect of pre-transplant MELD on post transplant survival.…”

Section: Meld In Liver Transplantationmentioning

confidence: 99%

The model for end-stage liver disease (MELD)

2007

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The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver trans- becoming the standard by which priorities in donor liver allocation were determined. Since the score was first derived in a relatively small number of patients undergoing the transjugular intrahepatic portosystemic shunts (TIPS) procedure, it has been validated in many different populations of patients with liver disease. Within a relatively short period of time, MELD became a common metric by which the severity of liver disease could be accurately described.In this paper, we review the initial development and validation of the MELD score, its application in organ allocation and management of patients with a variety of liver conditions, its strengths and limitation, and current and future efforts to refine and improve it further. Creation and Validation of MELDMELD was initially created to predict survival following elective placement of TIPS. 1 The model was subsequently validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity (e.g., hospitalized and ambulatory patients), as well as patients of geographically and temporally diverse origin. 2 The survival model was initially termed the "Mayo End-Stage Liver Disease" or "MELD" model to acknowledge the affiliation of the investigators who created the model. During discussions leading to the establishment of MELD as the basis for prioritization of organs for liver transplantation, 3,4 we changed the name to "Model for End-Stage Liver Disease" which maintained the acronym "MELD", but removed the association with a particular institution, a process that was thought would lead to wider acceptance of the model. MELD incorporates 3 widely available laboratory variables including the international normalized ratio (INR), serum creatinine, and serum bilirubin. The original mathematical formula for MELD is: MELD ϭ 9.57 ϫ log e (creatinine) ϩ 3.78 ϫ Log e (total bilirubin) ϩ 11.2 ϫ Log e (INR) ϩ 6.43.The score can be calculated on handheld computing devices, and is available at www.mayoclinic.org/gi-rst/ mayomodel5.html. When the model was initially created the etiology of cirrhosis was also included. In the TIPS

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Pretransplant MELD Score As a Predictor of Outcome After Liver Transplantation for Chronic Hepatitis C

Cited by 63 publications

References 19 publications

Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

The model for end-stage liver disease (MELD)

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