Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK.
The Model for End-Stage Liver Disease (MELD) or similar scoring system is proposed in the UK for prioritization for liver transplantation. We evaluated the reproducibility of creatinine measurements and therefore MELD scores in four liver transplant units in the UK.


METHODS
All transplant units were invited to participate; four agreed to do so, contributing 36 patients awaiting liver transplantation. Blood was collected from these 36 and divided into aliquots then sent to the four participating centres. Every centre measured creatinine and bilirubin for every patient. The results were analysed for the degree of agreement between centres for creatinine and MELD scores using the Bland-Altman method and Wilcoxon rank test.


RESULTS
The mean creatinine value varied from 101 mumol/l in centre C to 110 micromol/l for the same sample in centre A, with significant differences between the four centres (P < 0.05, Wilcoxon signed-rank test). The MELD scores were significantly different between centre C and all other centres (P < 0.05).


CONCLUSIONS
This study demonstrates lack of agreement in measurement of serum creatinine and MELD scoring between four UK transplant centres. A difference in two MELD points can have a significant impact on patient outcome, and these factors will have to be addressed if a UK-wide transplant list is to be initiated.
Goulding
Carol
C
The Liver Unit, The Royal Free Hospital, London, UK.
Cholongitas
Evangelous
E
Nair
Devi
D
Kerry
Andrew
A
Patch
David
D
Akyol
Murat
M
Walker
Simon
S
Manas
Derek
D
Mc Clure
David
D
Smith
Liesl
L
Jamieson
Neville
N
Oberg
Ingela
I
Cartwright
David
D
Burroughs
Andrew K
AK
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007494:Ireland; D007668:Kidney / Q000503:physiopathology; D008107:Liver Diseases / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D006113:United Kingdom; D014850:Waiting Lists
D003404:Creatinine; D001663:Bilirubin