MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation

Gregorio Santori, Enzo Andorno, Nicola Morelli, Adelmo Antonucci, Giuliano Bottino, Rosalia Mondello, Andrea Gianelli Castiglione, Roberto Valente, Ferruccio Ravazzoni, Stefano Di Domenico, Umberto Valente

Research output: Contribution to journalArticlepeer-review

Abstract

The Model for End-stage Liver Disease (MELD) provides a score able to predict short-term mortality in patients awaiting liver transplantation (LT). In the early 2002, United Network for Organ Sharing (UNOS) has proposed to replace the conventional statuses 3, 2B, and 2A with a modified MELD score. However, the accuracy of the MELD model to predict post-transplantation outcome is fairly elusive. In the present study we investigated the predictive value of the MELD score for short-term patient and graft mortality in comparison with conventional UNOS status. Sixty-nine patients listed at UNOS status 3 (n = 5), 2B (n = 55) or 2A (n = 9) who underwent LT were enrolled according to strict criteria. No donor-related parameters affected 3-month patient survival. Through univariate Cox regression, pretransplantation international normalized ratio (P = 0.049) and activated partial thromboplastin time (P = 0.032) were significantly associated with 3-month patient survival, although not in the subsequent multivariate analysis. The overall MELD score was 17 ± 6.63 (median: 16, range: 4-34), increasing from UNOS Status 3 to 2A (r2 = 0.171, P = 0.0001). No significant difference occurred in the median MELD score between patients who underwent a second LT and those who did not (P = 0.458). The inter-rate agreement between UNOS status and MELD score after categorization for clinical urgency showed a fair agreement (κ = 0.244). The 3-month patient and graft mortality was 15.94% and 20.29% respectively. The concordance statistic did not find significance between UNOS status and MELD score for 3-month patient (P = 0.283) or graft mortality (P = 0.957), although the MELD score revealed a major sensitivity for short-term patient mortality (0.637; 95%CI: 0.513-0.75). These findings suggest the need to implement MELD model accuracy for both inter-rate agreement with UNOS Status and patient outcome.

Original languageEnglish
Pages (from-to)65-72
Number of pages8
JournalTransplant International
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 2005

Keywords

  • International normalized ratio
  • Liver transplantation
  • Model for End-stage Liver Disease score
  • Mortality
  • United Network for Organ Sharing status

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'MELD score versus conventional UNOS status in predicting short-term mortality after liver transplantation'. Together they form a unique fingerprint.

Cite this