Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina
Background. MELD or MELD sodium promotes sicker patients for earlier liver transplantation (LT); the balance between pre- and post-LT outcomes is still controversial. Aim. To compare MELD and related scores’ risk assessment of short-term morbidity and mortality after LT. Methods. We included only transplanted cirrhotic patients from 6/2005 to 6/2010 ( ). Immediate pre-LT MELD, integrated MELD (iMELD), and two MELD sodium formulas “MELD Na1” and “MELDNa2” were calculated. Results. Pre-LT scores for nonsurvivors were higher than those for survivors: MELD (28 ± 8 versus 22 ± 7, ), MELD Na1 (33 ± 8 versus 27 ± 10, ), and iMELD (51 ± 6 versus 46 ± 8, ). Patient survival assessment was performed by AUROC analysis (95% CI): MELD 0.694 (0.56–0.82; ), MELD Na1 0.682 (0.56–0.79; ), MELD Na2 0.651 (0.54–0.76; ), and iMELD 0.698 (0.593–0.80; ). Patients with MELD ≥25 points had longer intensive care stay (mean 10 versus 7 days, ) and longer mechanical ventilatory support (5.4 versus 1.9 days, ). Conclusions. The addition of serum sodium to MELD does not improve assessment of mortality after LT. Patients with higher MELD may preclude higher morbidity after transplantation. 1. Introduction Organ shortage and waiting list mortality have focused increased attention on improving liver transplants candidates’ stratification. In recent years there has been increasing debate concerning the most appropriate allocation system of organs for liver transplantation. The Model for End-Stage Liver Disease (MELD) score [1] which is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), has been adopted as the allocation system in the United States in 2002. Argentina has been the second country in the world to adopt this score for organ allocation in July 2005. The MELD score accurately predicts short-term waiting list mortality in approximately 80% of patients with cirrhosis [2]; however, there are approximately 15–20% of patients that are not correctly categorized by MELD [3]. This is why several studies in an attempt to improve MELD’s waiting list performance proposed the addition of other variables such as serum sodium and age to the formula [4, 5]. At the same time, the precise relationship between severity of illness at transplantation and outcome after LT is unclear. There is a need for better pretransplant predictors of pre-LT and post-LT outcomes. It has been argued that the use of MELD or related scores to prioritize patients could result in a decrease in posttransplant survival, as sicker patients will have priority for transplantation. However, neither MELD
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