Modified Model for End-Stage Liver Disease eXcluding INR (MELD-XI) Score Predicts Early Death After Pediatric Heart Transplantation

Abstract

The MELD-XI scoring system can be used in pediatric orthotopic heart transplant to identify patients at risk for poor outcomes. Because long-term survival is largely driven by early death, renal insufficiency and congestive hepatopathy should be optimized before transplant.

Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

“…(35) Elevated MELD-XI scores prior to adult and pediatric heart transplantation also predicted adverse post-cardiac transplant outcomes, including 1-year mortality in multiple studies. (37)(38)(39) In a recent investigation, patients with a MELD-XI ≥ 19 had higher odds of all-cause mortality (HR, 1.17; P = 0.013). (36) However, although the MELD-XI score appears to be a useful tool in predicting cardiac morbidity and mortality in CH, whether or not it is useful in predicting hepatic outcomes is unknown.…”

“…One prospective study of 18 post‐Fontan patients found that higher MELD‐XI scores independently correlated to the composite endpoint of increased incidence of sudden cardiac death, death from congestive heart failure, and need for cardiac transplantation (hazard ratio [HR], 7.76; 95% confidence interval, 2.05‐29.33; P = 0.008) . Elevated MELD‐XI scores prior to adult and pediatric heart transplantation also predicted adverse post–cardiac transplant outcomes, including 1‐year mortality in multiple studies . In a recent investigation, patients with a MELD‐XI ≥ 19 had higher odds of all‐cause mortality (HR, 1.17; P = 0.013) .…”

“…(2) In concordance with its correlation with liver fibrosis scores, the MELD-XI score appears to be more useful in predicting clinically significant patient outcomes in the CH population than other prediction tools. (19,20,(35)(36)(37)(38)(39) One prospective study of 18 post-Fontan patients found that higher MELD-XI scores independently correlated to the composite endpoint of increased incidence of sudden cardiac death, death from congestive heart failure, and need for cardiac transplantation (hazard ratio [HR], 7.76; 95% confidence interval, 2.05-29.33; P = 0.008). (35) Elevated MELD-XI scores prior to adult and pediatric heart transplantation also predicted adverse post-cardiac transplant outcomes, including 1-year mortality in multiple studies.…”

Surveillance for liver complications after the Fontan procedure

“…26 Baek et al 27 to predict short-term survival in patients with cirrhosis whose INR is artificially elevated by anticoagulation 28 and has subsequently been used to predict mortality after cardiac transplantation. 29,30 A recent retrospective review of Fontan patients who underwent transvenous hepatic biopsy at the time of routine cardiac catheterization revealed a positive correlation between MELD-XI and hepatic fibrosis scores on pathology (correlation coefficient 5 0.4; P 5 .003), although receiver operator characteristic analysis did not identify a score cutoff with adequate sensitivity and specificity. 31 These scores appear to be promising, but the specific cutoffs to diagnose or rule out cirrhosis in the Fontan population need to be validated.…”

Congestive hepatopathy: Differentiating congestion from fibrosis

“…The MELD‐XI (MELD without INR) was developed to eliminate the variable of anticoagulation in patients with combined cardiac and hepatic dysfunction. The MELD‐XI offers more promise for risk stratification in this patient population as multiple studies demonstrate that MELD‐XI predicts important clinical outcomes including liver decompensation and death . The MELD‐XI may also be useful in determining candidacy for heart transplantation or combined heart and liver transplantation, although no specific validation studies for this use currently exist.…”