The Impact of the Meld Score on Liver Transplant Allocation and Results: An Integrative Review

Moraes, Ana Claudia Oliveira de; Oliveira, Priscilla Caroliny de; Fonseca-Neto, Olival Cirilo Lucena da

doi:10.1590/0102-6720201700010018

Cited by 24 publications

(21 citation statements)

References 24 publications

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“…However, as the field of pediatric transplantation progresses, it becomes increasingly important to include other metrics beyond mortality and address them to mitigate risk factors and improve outcomes. For example, while PELD and MELD scoring systems have led to a drastic decrease in mortality, it has been shown that their implementation has actually led to increased costs and that the score alone is not a perfect predictor of post‐transplantation complications 5‐8 . Meanwhile, other variables have been shown to be associated with complications following surgery and, in particular, the post‐transplant LOS in the hospital 9‐13 .…”

Section: Introductionmentioning

confidence: 99%

Pediatric length‐of‐stay index following liver transplantation

Zhang

Barrett

Cotton

et al. 2020

Pediatric Transplantation

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In the past several decades, pediatric liver transplantation mortality has continued to decline; this is notable given that the indications for pediatric liver transplantation have broadened and become increasingly complex. 1-3 This reduction in mortality is due in large part to not only new surgical techniques, but also the implementation of standardized scoring systems, such as the PELD and MELD scores, which prioritize patients based on the severity of disease. 4 However, as the field of pediatric transplantation progresses, it becomes increasingly important to include other metrics beyond mortality and address them to mitigate risk factors and improve outcomes. For example, while PELD and MELD scoring systems have led to a drastic decrease in mortality, it has been shown that their implementation has actually led to increased costs and that the score alone is not a perfect predictor of post-transplantation complications. 5-8 Meanwhile, other variables have been shown to be associated with complications following surgery and, in particular, the post-transplant LOS in the hospital. 9-13 Importantly,

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Section: Introductionmentioning

confidence: 99%

Pediatric length‐of‐stay index following liver transplantation

Zhang

Barrett

Cotton

et al. 2020

Pediatric Transplantation

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“…However, patients must be seriously ill to warrant LT. Conversely, those deemed too well, often by MELD score, can be de‐listed or placed on hold. While the use of MELD has shorted time on the waitlist, time that nevertheless elapses may correspond to further decompensation of liver disease and a decline in KPSS, some of which may be attributable to age‐related factors, by the time transplant is undertaken . Moreover, implementation of MELD in the U.S. has since led to increased average MELD at time of transplantation, which would signify that such patients are at higher risk of mortality, but decreased waitlist mortality due to the allocation of grafts to sicker patients .…”

Section: Discussionmentioning

confidence: 99%

More severe deficits in functional status associated with higher mortality among adults awaiting liver transplantation

McCabe

Wong

2018

Clinical Transplantation

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The impact of functional status on liver transplant (LT) waitlist outcomes is not well studied. Early evidence suggests frailty portends increased mortality. We aim to evaluate the association of functional status with LT waitlist survival and the probability of receiving LT among adults with cirrhosis. Using 2005-2016 United Network for Organ Sharing (UNOS) data, we retrospectively assessed the association of functional status, as determined by Karnofsky Performance Status Score (KPSS) with LT waitlist survival and the probability of receiving LT using Kaplan-Meier and multivariate Cox proportional hazard models. Among 118 954 patients listed for LT, patients with worse Karnofsky scores, indicating poor functional status, were progressively more likely to receive liver transplantation compared to patients with better scores, with the most functionally disabled group having 68% higher probability of receiving LT (HR 1.68; 95% CI 1.61-1.75, P < 0.001). Worse functional status was associated with increased waitlist mortality, with the most functionally disabled group 97% more likely to die on the waitlist (HR 1.97; 95% CI 1.81-2.16, P < 0.001). In conclusion, among patients awaiting LT, worse functional status was associated with significantly higher waitlist mortality.

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“…MELD score is incorporated only 3 objective variables, including total bilirubin, creatinine and INR. Studies has proved that the MELD score system could reduce the death rate in patients waiting for a liver transplantation, and downgrading MELD score can improve the outcomes after liver transplantation in patients with acute-on-chronic hepatitis B liver failure [15,16]. The Child-Pugh score, based on clinical symptoms of insu cient liver function (ascites/encephalopathy), and laboratory analysis of parameters of liver function (albumin, bilirubin, and PT) can be used to identify low or high-risk patients [17].…”

Section: Disccusionmentioning

confidence: 99%

Prognosis of Liver Transplantation: Does Postoperative Ileus Matter ?

Bai

Han

et al. 2020

Preprint

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Background: Nowadays, liver transplantation has become a main therapy for end-stage liver disease. However, studies show that there are high mortality and severe complications after liver transplantation. Although gastrointestinal dysfunction is a common and major complication among complications, there was rarely relative research. The study aims to elucidate the factors about ileus after liver transplantation and patients’ survival rate. Methods: We collected data (n=318, 2016–2019) from the First Affiliated Hospital of Xi’an Jiaotong University. After excluding cases, a total of 293 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. We reviewed 38 variables (including preoperative, operative and postoperative relative factors). In addition, other complications after liver transplantation and survival data were compared among groups. Results: Of the 293 patients, 23.2% (n=68) experienced postoperative ileus. Ileus patients were not different with non-ileus patients in preoperative, operative and postoperative factors. HBV-positive patients with ileus had a lower MELD score (P=0.025), and lower postoperative total bilirubin was correlated with ileus (P=0.049). Besides, Child-Pugh score of HCC patients with ileus was low (P=0.029). The complications after liver transplantation and survival rate were all not different among groups. Conclusions: According to our research, compared with non-ileus patients, we didn’t obtain the risk factors for patients with ileus. Ileus-patients didn’t increase complications after liver transplantation and didn’t decrease post-LT survival rates. But the preoperative MELD score and postoperative total bilirubin of HBV-positive patients with ileus were lower, and Child-Pugh score of HCC patients with ileus was also lower.

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The Impact of the Meld Score on Liver Transplant Allocation and Results: An Integrative Review

Cited by 24 publications

References 24 publications

Pediatric length‐of‐stay index following liver transplantation

Pediatric length‐of‐stay index following liver transplantation

More severe deficits in functional status associated with higher mortality among adults awaiting liver transplantation

Prognosis of Liver Transplantation: Does Postoperative Ileus Matter ?

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