The decreasing predictive power of MELD in an era of changing etiology of liver disease

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Elizabeth L GodfreyAbbas Rana

Abstract

The field of liver transplantation has shifted considerably in the MELD era, including changing allocation, immunosuppression, and liver failure etiologies, as well as better supportive therapies. Our aim was to evaluate the predictive accuracy of the MELD score over time. The United Network for Organ Sharing provided de-identified data on 120 156 patients listed for liver transplant from 2002-2016. The ability of the MELD score to predict 90-day mortality was evaluated by a concordance (C-) statistic and corroborated with competing risk analysis. The MELD score's concordance with 90-day mortality has downtrended from 0.80 in 2003 to 0.70 in 2015. While lab MELD scores at listing and transplant climbed in that interval, score at waitlist death remained steady near 35. Listing age increased from 50 to 54 years. HCV-positive status at listing dropped from 33 to 17%. The concordance of MELD and mortality does not differ with age (>60 = 0.73, <60 = 0.74), but is lower in diseases that are increasing most rapidly-alcoholic liver disease and non-alcoholic fatty liver disease-and higher in those that are declining, particularly in HCV-positive patients (HCV positive = 0.77; negative = 0.73). While MELD still predicts mortality, its ac...Continue Reading

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Citations

Dec 10, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Allison KwongW Ray Kim
Jan 17, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Elizabeth L GodfreyAbbas Rana
Apr 19, 2020·Current Opinion in Organ Transplantation·Francois FaitotThierry Artzner
Jun 4, 2020·Current Opinion in Organ Transplantation·Javier BriceñoRubén Ciria
Jun 13, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Ben F J GoudsmitAndries E Braat
Jan 11, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Shunji NagaiDilip Moonka
Jul 6, 2020·Clinics in Liver Disease·Ariel Aday, Jacqueline G O'Leary
Sep 11, 2020·Transplantation·Tommy IvanicsGonzalo Sapisochin
Dec 11, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ben F J GoudsmitAndries E Braat
Jun 7, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Kristel K LeungZita Galvin
May 22, 2021·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Chathur Acharya, Jasmohan S Bajaj
Sep 6, 2021·Gastroenterology·W Ray KimAllison J Kwong

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