CORRELATION OF PRE-TRANSPLANT MELD SCORE WITH 30 AND 60 DAYS’ MORTALITY IN PATIENTS OF LIVER TRANSPLANT

Authors

  • Faryal Riaz Khan Khan Pak Emirates Military Hospital Rawalpindi
  • Rao Saad Ali Khan Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Khawar Shabbir Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Asim Shehzad Foundation University Medical College, Rawalpindi-Pakistan
  • Fuad Ahmad Siddiqi Combined Military Hospital, Rawalpindi-Pakistan
  • Zara Riaz Khan Pakistan Institute of Medical Sciences, Islamabad-Pakistan
  • Salahuddin DHQ Hospital, Haripur-Pakistan
  • Muhammad Bilal Khattak Hayatabad Medical Complex, Peshawar-Pakistan

DOI:

https://doi.org/10.55519/JAMC-03-13246

Abstract

Background: The Model for End-Stage Liver Disease (MELD) score, introduced in 2002 by the United Network for Organ Sharing (UNOS), is a vital tool for predicting mortality for liver transplant candidates. Comprising serum creatinine, serum bilirubin, and international normalized ratio (INR), the MELD score includes kidney, liver, and coagulation pathway function, providing a comprehensive prognostic tool. Recent studies suggest broader prognostic implications, extending beyond organ allocation. Despite its benefits, around 15%-20% of patients may not experience accurate survival predictions. Methods: This retrospective single-center study, covering January 2016 to September 2023 with 87 patients, explores the correlation between pre-transplant MELD scores and 30 to 60-day post-transplant survival. Results: Our analysis reveals no significant impact of MELD scores on survival during this period, challenging existing literature (p=0.068). The study underscores the need for nuanced risk assessment beyond MELD scores, considering diverse clinical scenarios and patient-specific variables. Conclusion: Our findings contribute to refining predictive models and advocate for larger-scale investigations, emphasizing a holistic approach to optimize liver transplantation outcomes.

References

Onaca NN, Levy MF, Sanchez EQ, Chinnakotla S, Fasola CG, Thomas MJ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation. Liver Transpl 2003;9(2):117–23.

Kamath P, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33(2):464–70.

Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124(1):91–6.

Roth JA, Chrobak C, Schädelin S, Hug BL. MELD score as a predictor of mortality, length of hospital stay, and disease burden: A single-center retrospective study in 39,323 inpatients. Medicine 2017;96(24):e7155.

Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, et al. Hepatic Dysfunction in Ambulatory Patients With Heart Failure. J Am Coll Cardiol 2013;61(22):2253–61.

Biegus J, Zymliński R, Sokolski M, Siwołowski P, Gajewski P, Nawrocka‐Millward S, et al. Impaired hepato‐renal function defined by the MELD XI score as prognosticator in acute heart failure. Eur J Heart Fail 2016;18(12):1518–21.

Sivayoham N, Rhodes A, Cecconi M. The MISSED score, a new scoring system to predict Mortality In Severe Sepsis in the Emergency Department: a derivation and validation study. Eur J Emerg Med 2014;21(1):30–6.

Said A. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol 2004;40(6):897–903.

Fischer CM, Yano K, Aird WC, Shapiro NI. Abnormal Coagulation Tests Obtained in the Emergency Department are Associated with Mortality in Patients with Suspected Infection. J Emerg Med 2012;42(2):127–32.

Sern Lim H. Baseline MELD-XI score and outcome from veno-arterial extracorporeal membrane oxygenation support for acute decompensated heart failure. Eur Heart J Acute Cardiovasc Care 2016;5(7):82–8.

Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007;45(3):797–805.

Moraes ACO, Oliveira PC, Fonseca-Neto OCLD. The impact of the meld score on liver transplant allocation and results: an integrative review. Arq Bras Cir Dig 2017;30(1):65–8.

Morales-Arráez D, Ventura-Cots M, Altamirano J, Abraldes JG, Cruz-Lemini M, Thursz MR, et al. The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study. Am J Gastroenterol 2022;117(2):301–10.

Mehmood T, Zia M, Latif A, Ansar S. Mortality Related Factors in Patients with Variceal Bleeding with MELD Score ≥18. J Coll Physicians Surg Pak 2019;29(12):1199–202.

Diaz Soto JC, Mauermann WJ, Lahr BD, Schaff H V, Luis SA, Smith MM. MELD and MELD XI Scores as Predictors of Mortality After Pericardiectomy for Constrictive Pericarditis. Mayo Clin Proc 2021;96(3):619–35.

Samuel D, Coilly A. Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation. BMC Med 2018;16(1):113.

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Published

2024-09-08