Validation of MELD3.0 in 2 centers from different continents

Area of Science:

• Hepatology
• Transplant Surgery
• Medical Statistics

Background:

• The Model for End-Stage Liver Disease (MELD) score is crucial for liver transplant waiting list (WL) stratification.
• Historical data suggests women face disadvantages in accessing liver transplantation.
• MELD3.0 was developed to address potential sex-based disparities in liver transplant access.

Purpose of the Study:

• To validate the predictive performance of the MELD3.0 score in two distinct patient populations.
• To assess if MELD3.0 improves the stratification of patients on the liver transplant waiting list compared to existing scores.
• To evaluate MELD3.0's accuracy in predicting 90-day mortality, with a focus on potential differences between sexes.

Main Methods:

• A retrospective cohort study was conducted across two centers (Toronto, Canada, and Valencia, Spain).
• Adult patients added to the liver transplant WL between 2015 and 2019 were included, excluding those with short-term survival indications not captured by MELD.
• Patients had a minimum follow-up of 3 months post-WL inclusion.

Main Results:

• MELD3.0 (AUC 0.930) and MELD-Na (AUC 0.921) demonstrated superior 90-day mortality prediction compared to MELD (AUC 0.879).
• MELD3.0 did not show statistical superiority over MELD-Na (p=0.144).
• MELD3.0 significantly improved prediction for women (p=0.032) compared to MELD, reclassifying 24% of patients, primarily in the MELD 10-19 range.

Conclusions:

• MELD3.0 is validated across heterogeneous centers, offering improved mortality prediction for women on the liver transplant WL without disadvantaging men.
• The study did not find MELD3.0 to be statistically superior to MELD-Na in these cohorts.
• MELD3.0 demonstrates potential for refining liver transplant waiting list management, especially for female patients.