Impact of dynamic changes in MELD score on survival after liver transplantation – a Eurotransplant registry analysis

Györi, Georg; Silberhumer, Gerd R.; Rahmel, Axel; Vries, Erwin de; Soliman, Thomas; Zehetmayer, Sonja; Rogiers, Xavier; Berlakovich, Gabriela; Eurotransplant,

doi:10.1111/liv.13075

Cited by 20 publications

(28 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently in 2016, an analysis of the Eurotransplant registry of nearly 6,000 patients showed a correlation between transplant list mortality and delta-MELD, as well as an effect of delta-MELD on posttransplant survival, with delta-MELD > 10 showing a 1.6-fold increased risk of death after transplantation. 35 These more recent results require further validation but the concept of a dynamic study of MELD seems interesting, not only for patients undergoing aggravation who may need a faster transplantation but also to flesh out the concept of futility in patients worsening very rapidly with a high risk of posttransplant mortality.…”

Section: Meld Score Dynamic Delta-meldmentioning

confidence: 99%

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

Sacleux

Samuel

2019

Semin Liver Dis

View full text Add to dashboard Cite

In a context of global organ shortage, the Model for End-Stage Liver Disease (MELD) score seems to be a fair prioritization tool, with a paradigm: “sickest first.” Since its introduction in the United States in 2002, it has been rapidly adopted by transplant centers and organ sharing agencies around the world. The MELD score showed its effectiveness with a 12% reduction in waiting list mortality in the United States. Its success is linked to its simplicity, the use of basic variables (serum creatinine, serum bilirubin, and international normalized ratio [INR]), and its ability to predict short-term mortality, particularly on the transplant waiting list. However, this score is not perfect: its variables may have disadvantages for some patients, especially women, with serum creatinine and interlaboratory variability of the INR. The MELD score does not take into account some variables associated with poor short-term prognosis in cirrhotic patients. In addition, it is currently capped at 40, which results in the exclusion of sicker patients who could greatly benefit from transplantation. Finally, the MELD score does not accurately reflect the prognosis of several conditions, requiring a MELD exception system. Some solutions have been suggested such as MELD-Na or MELD uncapping, but it has not yet been fully accepted by all transplant centers.

show abstract

Section: Meld Score Dynamic Delta-meldmentioning

confidence: 99%

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

Sacleux

Samuel

2019

Semin Liver Dis

View full text Add to dashboard Cite

show abstract

“…The Model for End-Stage Liver Disease (MELD) was introduced to standardize assessment of waitinglist mortality nearly 2 decades ago and has become a central part of liver allocation throughout the United States and Europe. (7,9) Subsequently, the original MELD was adapted through inclusion of serum sodium (NA) concentrations (MELD-Na), which led to improved prediction of early mortality on the waiting list for OLT. (10,11) Still, MELD-Na is prone to well-known limitations that comprise the lack of assessment of subclinical infection while on the waiting list and an underestimation of complications resulting from portal hypertension.…”

mentioning

confidence: 99%

The von Willebrand Factor Facilitates Model for End‐Stage Liver Disease–Independent Risk Stratification on the Waiting List for Liver Transplantation

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background and Aims The Model for End‐Stage Liver Disease (MELD) is used for clinical decision‐making and organ allocation for orthotopic liver transplantation (OLT) and was previously upgraded through inclusion of serum sodium (Na) concentrations (MELD‐Na). However, MELD‐Na may underestimate complications arising from portal hypertension or infection. The von Willebrand factor (vWF) antigen (vWF‐Ag) correlates with portal pressure and seems capable of predicting complications in patients with cirrhosis. Accordingly, this study aimed to evaluate vWF‐Ag as an adjunct surrogate marker for risk stratification on the waiting list for OLT. Approach and Results Hence, WF‐Ag at time of listing was assessed in patients listed for OLT. Clinical characteristics, MELD‐Na, and mortality on the waiting list were recorded. Prediction of 3‐month waiting‐list survival was assessed by receiver operating characteristics and net reclassification improvement. Interestingly, patients dying within 3 months on the waiting list displayed elevated levels of vWF‐Ag (P < 0.001). MELD‐Na and vWF‐Ag were comparable and independent in their predictive potential for 3‐month mortality on the waiting list (area under the curve [AUC], vWF‐Ag = 0.739; MELD‐Na = 0.764). Importantly, a vWF‐Ag cutoff at 413% identified patients at risk for death within 3 months of listing with a higher odds ratio (OR) than the previously published cutoff at a MELD‐Na of 20 points (vWF‐Ag, OR = 10.873, 95% confidence interval [CI], 3.160, 36.084; MELD‐Na, OR = 7.594, 95% CI, 2.578, 22.372; P < 0.001, respectively). Ultimately, inclusion of vWF‐Ag into the MELD‐Na equation significantly improved prediction of 3‐month waiting‐list mortality (AUC, MELD‐Na–vWF = 0.804). Conclusions A single measurement of vWF‐Ag at listing for OLT predicts early mortality. Combining vWF‐Ag levels with MELD‐Na improves risk stratification and may help to prioritize organ allocation to decrease waiting‐list mortality.

show abstract

“…C, Likelihood of waitlist removal due to clinical improvement in Group 2: There was a significant difference in likelihood of removal between these groups (P = .008). D, Waitlist mortality in Group 1 (initial MELD-Na score of [6][7][8][9][10][11][12][13][14]: Unadjusted waitlist mortality rates were similar (P = .45). E, Transplant probability in Group 1: There was a significant difference in transplant probability and likelihood of removal between groups (P < .001).…”

Section: Discussionmentioning

confidence: 99%

A Share 21 model in liver transplantation: Impact on waitlist outcomes

Nagai

Chau

Kitajima

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

Services Final Rule stated that patients on organ transplant waitlists should be ranked by "medical urgency."1 The Model for End-Stage Liver Disease (MELD) score-based liver allocation was introduced in the United States in 2002.2-4 A major change was introduced to the liver allocation system, in 2016, with adoption of the MELD-Na score in response to the findings in a study by Kim et al.5 The study found that incorporation of serum sodium into the MELD formula allowed better discrimination of waitlist mortality than the MELD score. Allocation rules for higher-score patients have been modified with "Share 35," but the share rule for lower score patients has remained unchanged for over a decade. In 2005, Merion et al6 demonstrated

show abstract

Impact of dynamic changes in MELD score on survival after liver transplantation – a Eurotransplant registry analysis

Abstract: The concept of DeltaMELD was validated in a large, prospective data set. It provides a simple tool to identify patients with increased risk of death after liver transplantation and might help improve long-term results.

Cited by 20 publications

References 27 publications

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

The von Willebrand Factor Facilitates Model for End‐Stage Liver Disease–Independent Risk Stratification on the Waiting List for Liver Transplantation

A Share 21 model in liver transplantation: Impact on waitlist outcomes

Contact Info

Product

Resources

About