title: A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras.
abstract: BACKGROUND
  The model for end stage liver disease (MELD)-based organ allocation system is designed to prioritize orthotopic liver transplantation (OLT) for patients with the most severe liver disease. However, there are no published data to confirm whether this goal has been achieved or whether the policy has affected long-term post-OLT survival.
  
  
  OBJECTIVE
  To compare pre-OLT liver disease severity and long-term (1 year) post-OLT survival between the pre- and post-MELD eras.
  
  
  METHODS
  Using the United Network of Organ Sharing database, we compared two cohorts of adult patients undergoing cadaveric liver transplant in the pre-MELD (n = 3857) and post-MELD (n = 4245) eras. We created multivariable models to determine differences in: (i) pre-OLT liver disease severity as measured by MELD; and (ii) 1-year post-OLT outcomes.
  
  
  RESULTS
  Patients undergoing OLT in the post-MELD era had more severe liver disease at the time of transplantation (mean MELD = 20.5) vs. those in the pre-MELD era (mean MELD = 17.0). There were no differences in the unadjusted patient or graft survival at 1 year post-OLT. This difference remained insignificant after adjusting for a range of prespecified recipient, donor, and transplant centre-related factors in multivariable survival analysis.
  
  
  CONCLUSIONS
  Although liver disease severity is higher in the post- vs. pre-MELD era, there has been no change in long-term post-OLT patient or graft survival. These results indicate that the MELD era has achieved its primary goals by allocating cadaveric livers to the sickest patients without compromising post-OLT survival.
authors.affiliation: VA Greater Los Angeles Health Care System, Division of Gastroenterology/Hepatology, David Geffen School of Medicine, UCLA, Los Angeles, CA 90073, USA.
authors.forename: F
authors.initials: F
authors.lastname: Kanwal
authors.forename: G S
authors.initials: GS
authors.lastname: Dulai
authors.forename: B M R
authors.initials: BM
authors.lastname: Spiegel
authors.forename: H F
authors.initials: HF
authors.lastname: Yee
authors.forename: I M
authors.initials: IM
authors.lastname: Gralnek
mesh_terms: D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods; D016896:Treatment Outcome