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For patients awaiting liver transplantation (LT), a high Model for End-Stage Liver Disease (MELD) score driven by creatinine indicates poorer survival. This MELD subtype, particularly in women, warrants closer monitoring and may influence organ allocation strategies.

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Area of Science:

  • Hepatology
  • Nephrology
  • Transplant Surgery

Background:

  • Kidney dysfunction significantly impacts prognosis for patients with decompensated cirrhosis awaiting liver transplantation (LT).
  • The Model for End-Stage Liver Disease (MELD) score is a key predictor of mortality risk in this population.
  • It is hypothesized that the specific component driving a MELD score (creatinine, bilirubin, or INR) may influence patient outcomes.

Purpose of the Study:

  • To investigate whether the primary driver of a MELD score affects patient outcomes before and after LT.
  • To compare the intent-to-treat (ITT) survival rates among different MELD score subtypes.
  • To identify potential disparities in outcomes based on MELD score composition.

Main Methods:

  • Adult patients listed for LT between 2016-2020 were analyzed, excluding MELD exception cases and dual organ transplants.
  • K-Means clustering was used to classify patients into MELD-Br, MELD-INR, or MELD-Cr subtypes based on the dominant MELD score component.
  • One-year ITT survival was the primary outcome measure.

Main Results:

  • Three MELD subtypes were identified: MELD-Br (n=13,658), MELD-INR (n=13,809), and MELD-Cr (n=12,412).
  • One-year ITT survival rates were 78% for MELD-Br, 75% for MELD-INR, and significantly lower at 65% for MELD-Cr (p<0.01).
  • The MELD-Cr subtype exhibited higher MELD scores at listing, greater MELD decline over 3 months, increased waitlist mortality, and lower LT rates compared to other subtypes, especially in females.

Conclusions:

  • Patients with a MELD score predominantly driven by creatinine (MELD-Cr) have lower one-year ITT survival, even with equivalent listing practices.
  • MELD subtype classification offers a more nuanced approach to assessing dynamic mortality risk and guiding organ allocation.
  • Elevated creatinine as a MELD driver signifies a poorer prognosis, independent of the overall MELD score, highlighting the importance of kidney function assessment in LT candidates.