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  1. Home
  3. Variation In Intention-to-treat Survival By Meld Subtypes: All Models Created For End-stage Liver Disease Are Not Equal.
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  3. Variation In Intention-to-treat Survival By Meld Subtypes: All Models Created For End-stage Liver Disease Are Not Equal.

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Variation in intention-to-treat survival by MELD subtypes: All models created for end-stage liver disease are not

Craig Rosenstengle1, Marina Serper2, Sumeet K Asrani1

  • 1Baylor University Medical Center, Baylor Scott and White, Dallas, TX, United States.

Journal of Hepatology
|August 24, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

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.

Keywords:
Gender disparitiesKidney injuryLiver transplantPrognosis

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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.