title: MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation.
abstract: BACKGROUND
  The aim of this study was to determine the utility of the Model for End-Stage Liver Disease Excluding INR (MELD-XI) in predicting early outcomes (30 days and 1 year) and late outcomes (5 years) in patients after orthotopic heart transplantation (OHT).
  
  
  METHODS
  The United Network for Organ Sharing database was queried for all adult patients (aged ≥ 18 years) undergoing OHT from 2000 to 2012. A MELD-XI was calculated and the population stratified into score quartiles. Early and late survivals were compared among the MELD-XI cohorts. Multivariable Cox proportional hazards models were constructed to determine the capacity of MELD-XI (when modeled both as a categoric and a continuous variable) to predict 30-day, 1-year, and 5-year mortality. Conditional models were also designed to determine the effect of early mortality on long-term survival.
  
  
  RESULTS
  A total of 22,597 patients were included for analysis. The MELD-XI cutoff scores were established as follows: low (≤ 10.5), low-intermediate (10.6 to 12.6), intermediate-high (12.7 to 16.4), and high (>16.4). The high MELD-XI cohort experienced statistically worse 30-day, 1-year, and 5-year unconditional survivals when compared with patients with low scores (p < 0.001). Similarly, a high MELD-XI score was also predictive of early and late mortality (p < 0.001) after risk adjustment. There was, however, no difference in 5-year survival between the high score and low score cohorts after accounting for 1-year deaths. Subanalysis of patients bridged to transplant with a continuous-flow left ventricular assist device demonstrated similar findings.
  
  
  CONCLUSIONS
  This is the first known study to examine the relationship between a high MELD-XI score and outcomes in patients after OHT. Patients with hepatic or renal dysfunction before OHT should be closely monitored and aggressively optimized as early mortality appears to drive long-term outcomes.
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: J Trent
authors.initials: JT
authors.lastname: Magruder
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Dungan
authors.affiliation: Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Tedford
authors.affiliation: Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Glenn J R
authors.initials: GJ
authors.lastname: Whitman
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: csciort2@jhmi.edu.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Sciortino
mesh_terms: D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D018570:Risk Assessment; D013997:Time Factors