title: Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK.
abstract: 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.
authors.affiliation: The Liver Unit, The Royal Free Hospital, London, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Goulding
authors.forename: Evangelous
authors.initials: E
authors.lastname: Cholongitas
authors.forename: Devi
authors.initials: D
authors.lastname: Nair
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerry
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Murat
authors.initials: M
authors.lastname: Akyol
authors.forename: Simon
authors.initials: S
authors.lastname: Walker
authors.forename: Derek
authors.initials: D
authors.lastname: Manas
authors.forename: David
authors.initials: D
authors.lastname: Mc Clure
authors.forename: Liesl
authors.initials: L
authors.lastname: Smith
authors.forename: Neville
authors.initials: N
authors.lastname: Jamieson
authors.forename: Ingela
authors.initials: I
authors.lastname: Oberg
authors.forename: David
authors.initials: D
authors.lastname: Cartwright
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: 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
chemical_list: D003404:Creatinine; D001663:Bilirubin