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Comparison of MELD, MELD-Na, and MELD 3.0 scoring systems for transplant prioritization in the Turkish population: A
Kenan Moral1, Murat Harputluoğlu2, Gülşah Fidan Özkumur3
1Department of Gastroenterology and Hepatology, Gazi University, Ankara, Turkey.
Abstract:
The Model for End-stage Liver Disease Sodium (MELD-Na) score predicts mortality in liver transplant candidates. MELD 3.0 has been proposed as an improved model for estimating mortality risk. This study evaluated MELD 3.0's predictive accuracy for short-term mortality among Turkish liver transplant candidates and compared its performance with MELD and MELD-Na scores. Patients listed both for deceased donor transplants and living donor transplants were analyzed in the study. The discriminative abilities of MELD, MELD-Na, and MELD 3.0 scores were assessed using the area under the receiver operating characteristic curve (AUROC). Comparisons between AUROC values used the DeLong test. The most predictive cutoff for MELD 3.0 was determined using the Youden index. Transplant-free survival was analyzed using the Kaplan-Meier method, with survival curves compared using the log-rank test. A total of 1689 patients were included in this nationwide, multicenter study. Hepatitis B was the leading cause of cirrhosis (29%, n=491), followed by metabolic dysfunction-associated steatohepatitis (20%, n=335). For 3-month mortality, MELD 3.0 had the highest AUROC (0.753), followed by MELD-Na (0.747) and MELD (0.725). The most predictive cutoff values were 18 for MELD and 21 for MELD-Na and MELD 3.0. Both MELD-Na and MELD 3.0 outperformed MELD ( p <0.001), but showed no significant difference between them ( p =0.17). MELD 3.0 and MELD-Na demonstrated superior performance to MELD in predicting 3-month mortality among Turkish liver transplant candidates, though their predictive accuracy was comparable. Further refinements are needed to enhance MELD 3.0's clinical utility.
Insights
MELD 3.0 and MELD-Na scores accurately predict short-term mortality in Turkish liver transplant candidates, outperforming the standard MELD score. However, MELD 3.0 requires further refinement for improved clinical utility.
Area of Science:
- Hepatology
- Transplantation Medicine
- Medical Statistics
Background:
- The Model for End-Stage Liver Disease Sodium (MELD-Na) score is crucial for predicting mortality in liver transplant candidates.
- MELD 3.0 is a proposed advancement to improve mortality risk estimation.
- Evaluating MELD 3.0's accuracy in diverse populations is essential for clinical adoption.
Purpose of the Study:
- To assess the predictive accuracy of MELD 3.0 for short-term mortality in Turkish liver transplant candidates.
- To compare the performance of MELD 3.0 against MELD and MELD-Na scores.
- To identify optimal cutoff values and evaluate transplant-free survival.
Main Methods:
- A nationwide, multicenter study included 1,689 liver transplant candidates.
- Discriminative abilities were assessed using the area under the receiver operating characteristic curve (AUROC).
- Transplant-free survival was analyzed using Kaplan-Meier and log-rank tests.
Main Results:
- MELD 3.0 demonstrated the highest AUROC (0.753) for 3-month mortality, followed by MELD-Na (0.747) and MELD (0.725).
- MELD-Na and MELD 3.0 significantly outperformed MELD (p<0.001) but were comparable to each other (p=0.17).
- Optimal cutoff values were identified as 18 for MELD and 21 for MELD-Na and MELD 3.0.
Conclusions:
- MELD 3.0 and MELD-Na show comparable and superior performance to MELD in predicting 3-month mortality for Turkish liver transplant candidates.
- While MELD 3.0 shows promise, further refinements are necessary to enhance its clinical utility.
- The study highlights the importance of population-specific validation for mortality prediction models.
