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The impact of MELD exception points for hydrothorax on posttransplant mortality: a propensity score-matched analysis
Sawsan Fathma1, Sarpong Boateng2, Ayesha Amatya3
1Department of Internal Medicine, Waterbury Hospital, Waterbury.
Background:
Hepatic hydrothorax is a challenging complication of end-stage liver disease, and.patients with this complication can receive model for end-stage liver disease (MELD) exception points if they meet specific criteria as defined by United Network for Organ Sharing (UNOS). This research aimed to analyze the effect of receiving MELD exception points for hepatic hydrothorax on posttransplant mortality, using a national transplant database.
Methods:
Patients >18 years in the UNOS database awaiting liver transplant between 2012 and 2023 were identified based on their petition for MELD exception points. Using a 1: 1 propensity score-matched analysis, 302 patients who received MELD exception points for hepatic hydrothorax were compared with 302 patients who did not receive MELD exception points.Demographic, clinical and laboratory values were compared. The primary outcome was posttransplant mortality. Multivariate logistic regression controlled for potential confounders.
Results:
No significant difference was observed in mean age (58.20 vs 57.62 years), mean initial MELD score (16.93 vs 16.54), or mean Child-Pugh score (9.77 vs 9.74) in patients with hepatic hydrothorax receiving MELD exception points versus their matched cohort who did not recieve exception points. The proportion of males was slightly higher among patients who received MELD exception points (57.6% males vs 53.6% males). A majority of patients in both groups had Child-Pugh grade C (>56%). Patients receiving MELD exception points for hepatic hydrothorax had a statistically significant 44% decrease in the odds of posttransplant death compared to those who did not (OR 0.56; 95% CI 0.37-0.88; P = 0.01). Among the combined cohort, each year increase in age resulted in a 3.9% increase in mortality (OR 1.04; 95% CI 1.01-1.07; P = 0.005), and every one-unit increase in serum creatinine resulted in a 40% increase in mortality (OR 1.40; 95% CI 1.03-1.92; P = 0.03).
Conclusion:
Receiving MELD exception points for hepatic hydrothorax is associated with a significant reduction in the odds of posttransplant mortality. These findings underscore the importance of MELD exception points for hepatic hydrothorax among patients with decompensated cirrhosis, potentially improving patient prioritization for liver transplantation and influencing clinical decision-making.
Insights
Receiving Model for End-Stage Liver Disease (MELD) exception points for hepatic hydrothorax significantly reduces post-transplant mortality in liver transplant candidates. This highlights the importance of MELD exception points for patients with decompensated cirrhosis.
Area of Science:
- Hepatology
- Transplant Surgery
- Medical Informatics
Background:
- Hepatic hydrothorax is a serious complication of end-stage liver disease.
- Patients with hepatic hydrothorax may qualify for MELD exception points.
- Prioritization for liver transplantation is crucial for these patients.
Purpose of the Study:
- To analyze the impact of MELD exception points for hepatic hydrothorax on post-transplant mortality.
- To evaluate the effectiveness of MELD exception points in improving outcomes for liver transplant candidates.
- To inform clinical decision-making regarding organ allocation.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database (2012-2023).
- Included patients over 18 awaiting liver transplant who petitioned for MELD exception points.
- Employed 1:1 propensity score-matched analysis comparing 302 patients with and 302 without MELD exception points for hepatic hydrothorax.
Main Results:
- No significant differences in age, initial MELD, or Child-Pugh scores between groups.
- Patients receiving MELD exception points for hepatic hydrothorax showed a 44% decrease in post-transplant mortality (OR 0.56).
- Increased age and serum creatinine were associated with higher post-transplant mortality.
Conclusions:
- MELD exception points for hepatic hydrothorax are linked to reduced post-transplant mortality.
- These findings emphasize the value of MELD exception points for prioritizing patients with decompensated cirrhosis.
- Improved patient prioritization can positively influence liver transplant outcomes.
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