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Preoperative delta-MELD score does not independently predict mortality after liver transplantation
Patrick G Northup1, Carl L Berg
1Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA, USA. pgn5qs@virginia.edu
Abstract:
Changes in model for end-stage liver disease (MELD) score of > or = 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 > or = 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 > or = 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.
Insights
A significant increase in Model for End-Stage Liver Disease (MELD) score before liver transplant does not predict posttransplant death. Absolute MELD score at transplant is the primary factor influencing mortality, not the rate of MELD score change.
Area of Science:
- Hepatology
- Transplantation Medicine
- Medical Statistics
Background:
- The Model for End-Stage Liver Disease (MELD) score predicts mortality in patients with end-stage liver disease.
- Changes in MELD score (delta-MELD) over 30 days are considered a predictor of death for patients awaiting liver transplantation.
Purpose of the Study:
- To investigate whether a positive change in MELD score within 30 days before liver transplantation predicts posttransplant mortality.
- To determine the independent predictive value of delta-MELD on posttransplant outcomes.
Main Methods:
- Calculated delta-MELD scores using MELD scores from the day of and 30 days prior to transplantation for 1510 UNOS patients.
- Employed multivariate modeling to identify predictors of posttransplant mortality.
Main Results:
- Patients with a delta-MELD score >= 5 had higher absolute MELD scores at transplant, reduced posttransplant survival, and increased mortality.
- Multivariate analysis indicated that the excess mortality was not attributable to high delta-MELD (p = 0.43).
- The majority of the excess risk for mortality was linked to the absolute MELD score at the time of transplantation (p < 0.001).
Conclusions:
- Posttransplant mortality in patients with rapidly worsening liver disease is primarily dependent on the absolute MELD score at transplantation, not the rate of change immediately preceding it.
- Allocation policymakers should not consider a high delta-MELD in the immediate pretransplant period as an indicator of greater posttransplant mortality.
