The influence of laboratory-induced MELD score differences on liver allocation: more reality than myth.
BACKGROUND
Liver allocation in Eurotransplant (ET) is based on the MELD score. Interlaboratory MELD score differences in INR and creatinine determination have been reported. The clinical implication of this observation has not been demonstrated.


METHODS
MELD scores were calculated in 66 patients with liver cirrhosis using bilirubin, creatinine, and INR analyzed in six liver transplant centers. Based on allocation results of ET, patients transplanted from December 2006 to June 2007 were divided according to MELD score in four groups. For each group, the influence of the match MELD on the probability of receiving a transplant was studied (Cox proportional hazards model).


RESULTS
Laboratory-dependent significant differences in MELD score were demonstrated. Cox proportional hazards model showed a significant association between MELD score and the probability of organ allocation. The unadjusted hazard ratio for receiving a liver transplant was significantly different between group 2 and group 4 (group 2: MELD 19-24; group 4: MELD > 30).


CONCLUSIONS
Laboratory-dependent significant differences in MELD score were observed between the six transplant centers. We demonstrated a significant association between the MELD score and the probability of organ allocation. The observed interlaboratory variation might yield a significant difference in organ allocation in patients with high MELD scores.
Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium. j.schouten@erasmusmc.nl
J N
JN
Schouten
S
S
Francque
H
H
Van Vlierberghe
I
I
Colle
F
F
Nevens
J
J
Delwaide
M
M
Adler
P
P
Starkel
D
D
Ysebaert
A
A
Gadisseur
B
B
De Winter
J M
JM
Smits
A
A
Rahmel
P
P
Michielsen
D002648:Child; D003404:Creatinine / Q000097:blood; D006801:Humans; D019934:International Normalized Ratio; D007753:Laboratories / Q000592:standards*; D017093:Liver Failure / Q000145:classification* / Q000601:surgery; D016031:Liver Transplantation / Q000592:standards*; D011379:Prognosis; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement; D014850:Waiting Lists
D003404:Creatinine