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Liver transplantation with the Meld system: a prospective study from a single European center
M Ravaioli1, G L Grazi, G Ballardini
1Liver and Multi-organ Transplantation, Sant 'Orsola-Malpighi Hospital, University of Bologna, Italy.
Abstract:
The efficacy of the Meld system to allocate livers has never been investigated in European centers. The outcome of 339 patients with chronic liver disease listed according to their Meld score between 2003 and 2005 (Meld era) was compared to 224 patients listed during the previous 2 years according to their Child score (Child era). During the Meld era, hepatocellular carcinomas (HCCs) had a 'modified' Meld based on their real Meld, waiting time and tumor stage. The dropouts were deaths, tumor progressions and too sick patients. The rate of removals from the list due to deaths and tumor progressions was significantly lower in the Meld than in the Child era: 10% and 1.2% versus 16.1% and 4.9%, p < 0.05. The 1-year patient survival on the list was significantly higher in the Meld era (84% vs. 72%, p < 0.05). The prevalence of transplantation for HCC increased from 20.5% in the Child to 48.9% in the Meld era (p < 0.001), but between HCCs and non-HCCs of this latter era the dropouts were comparable (9.4% vs. 14.9%, p = n.s.) as was the 1-year patient survival on the list (83% vs. 84%, p = n.s.). The Meld allocation system improved the outcome of patients with or without HCC on the list.
Insights
The liver allocation Meld system significantly improved patient outcomes in European centers. This system reduced patient removals from transplant lists and increased 1-year survival rates for those awaiting liver transplants.
Area of Science:
- Hepatology
- Transplantation Medicine
- Public Health
Background:
- The Model for End-Stage Liver Disease (Meld) score is widely used for liver transplant allocation.
- Its efficacy in European centers has not been previously investigated.
- Comparing Meld with the previous Child score system is crucial for understanding allocation improvements.
Purpose of the Study:
- To investigate the impact of the Meld score system on liver transplant outcomes in European centers.
- To compare patient survival and removal rates from the waiting list between the Meld and Child score eras.
- To assess the effect of Meld allocation on patients with and without hepatocellular carcinoma (HCC).
Main Methods:
- Retrospective analysis comparing 339 patients listed under Meld (2003-2005) with 224 patients listed under Child score (previous 2 years).
- Utilized a 'modified' Meld score for HCC patients, incorporating tumor stage and waiting time.
- Analyzed dropout rates (death, tumor progression, too sick) and 1-year patient survival on the waiting list.
Main Results:
- Significantly lower removal rates due to death and tumor progression in the Meld era (10% and 1.2%) compared to the Child era (16.1% and 4.9%).
- 1-year patient survival on the list was significantly higher in the Meld era (84%) versus the Child era (72%).
- Increased prevalence of HCC transplantation (48.9% vs. 20.5%) with comparable outcomes between HCC and non-HCC patients under Meld allocation.
Conclusions:
- The Meld allocation system demonstrably improved outcomes for patients on the liver transplant waiting list in European centers.
- It effectively reduced waitlist mortality and progression, enhancing overall patient survival.
- The system proved beneficial for both patients with and without hepatocellular carcinoma.
