title: Early post-transplant survival: Interaction of MELD score and hospitalization status.
abstract: OBJECTIVE
  Urgency-based allocation that relies on the MELD score prioritizes patients at the highest risk of waitlist mortality. However, identifying patients at greatest risk for short-term post-transplant mortality is needed in order to optimize the potential gains in overall survival obtained through improved long-term management of transplant recipients. There are limited data on the predictive ability of MELD score for early post-transplant mortality, and no data assessing the interaction between MELD score and hospitalization status.
  
  
  METHODS
  We analyzed UNOS data from 2002 to 2013 on 50,838 non-status 1 single-organ liver transplant recipients and fit multivariable logistic models to evaluate the association and interaction between MELD score and pre-transplant hospitalization status on short-term post-transplant mortality.
  
  
  RESULTS
  There was a significant interaction (p<0.01) between laboratory MELD score and hospitalization status on three-, six-, and 12-month post-transplant mortality in multivariable logistic models. This interaction was most pronounced in patients with a laboratory MELD score <25 transplanted from an ICU, whose adjusted predicted three-, six-, and 12-month post-transplant mortality approximated those of patients with a MELD score ⩾30. Compared to hospitalized patients with a MELD score of 30-34, those with a MELD score ⩾35 in an ICU had significantly increased risk of three-month (OR: 1.54, 95% CI: 1.21-1.97), 6-month (OR: 1.35, 95% CI: 1.09-1.67), and 12-month (OR: 1.25, 95% CI: 1.03-1.52) post-transplant mortality.
  
  
  CONCLUSIONS
  Pre-transplant ICU status modifies the risk of early post-transplant mortality, independent of MELD score. This should be considered when determining candidacy for transplantation in order to optimize efficient use of a scarce resource.
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania, United States.
authors: Therese
authors: T
authors: Bittermann
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania, United States.
authors: George
authors: G
authors: Makar
authors: Division of Gastroenterology, Department of Medicine, University of Pennsylvania, United States; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. Electronic address: david.goldberg@uphs.upenn.edu.
authors: David S
authors: DS
authors: Goldberg
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
keywords: Intensive care unit; MELD score; Short-term mortality