Impact of MELD Allocation System on Waiting List and Early Post-Liver Transplant Mortality.
OBJECTIVE
MELD allocation system has changed the clinical consequences on waiting list (WL) for LT, but its impact on mortality has been seldom studied. We aimed to assess the ability of MELD and other prognostic scores to predict mortality after LT.


METHODS
301 consecutive patients enlisted for LT were included, and prioritized within WL by using the MELD-score according to: hepatic insufficiency (HI), refractory ascites (RA) and hepatocellular carcinoma (HCC). The analysis was performed to predict early mortality after LT (8 weeks).


RESULTS
Patients were enlisted as HI (44.9%), RA (19.3%) and HCC (35.9%). The major aetiologies of liver disease were HCV (45.5%). Ninety-four patients (31.3%) were excluded from WL, with no differences among the three groups (p = 0.23). The remaining 207 patients (68.7%) underwent LT, being HI the most frequent indication (42.5%). HI patients had the shortest length within WL (113.6 days vs 215.8 and 308.9 respectively; p<0.001), but the highest early post-LT mortality rates (18.2% vs 6.8% and 6.7% respectively; p<0.001). The independent predictors of early post-LT mortality in the HI group were higher bilirubin (OR = 1.08; p = 0.038), increased iMELD (OR = 1.06; p = 0.046) and non-alcoholic cirrhosis (OR = 4.13; p = 0.017). Among the prognostic scores the iMELD had the best predictive accuracy (AUC = 0.66), which was strengthened in non-alcoholic cirrhosis (AUC = 0.77).


CONCLUSIONS
Patients enlisted due to HI had the highest early post-LT mortality rates despite of the shortest length within WL. The iMELD had the best accuracy to predict early post-LT mortality in patients with HI, and thus it may benefit the WL management.
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.
Juan
J
Jurado-García
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.
María
M
Muñoz García-Borruel
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
Manuel Luis
ML
Rodríguez-Perálvarez
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.
Patricia
P
Ruíz-Cuesta
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
Antonio
A
Poyato-González
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
Pilar
P
Barrera-Baena
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
Enrique
E
Fraga-Rivas
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
Guadalupe
G
Costán-Rodero
IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|Department of Hepatobiliary Surgery and Liver Transplantation. Reina Sofía University Hospital. Córdoba, Spain.
Javier
J
Briceño-Delgado
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
José Luis
JL
Montero-Álvarez
Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, Córdoba, Spain.|IMIBIC, Maimonides Biomedical Research Institute, Córdoba, Spain.|CIBERehd (Networked Biomedical Research Center in Hepatic and Digestive Disease).
Manuel
M
de la Mata-García
D000328:Adult; D000368:Aged; D001201:Ascites / Q000401:mortality / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy; D005260:Female; D048550:Hepatic Insufficiency / Q000401:mortality / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000458:organization & administration; D014850:Waiting Lists