title: Impact of Inter-Laboratory Variability on Model of End-Stage Liver Disease (MELD) Score Calculation.
abstract: BACKGROUND The model for end-stage liver disease (MELD) is a laboratory-based scoring system for assessing the severity of liver disease. Since 16 December 2006, MELD-based organ allocation for liver transplantation (LT) has been established in Germany to prioritize the sickest patients. The present study was designed to evaluate the effect of using different laboratories on the calculated MELD score, despite the use of mandatory round-robin testing for comparable of inter-laboratory results. MATERIAL AND METHODS Blood samples were taken from 10 patients with liver disease. Bilirubin, creatinine, and INR were measured in 6 different laboratories. The patients' MELD scores were calculated and the inter-laboratory variability was compared. RESULTS The highest discrepancy between the laboratories was 5 MELD score points and the highest inter-laboratory difference for bilirubin, INR, and creatinine was 4.6, 1.2, and 0.99 mg/dl, respectively. Pairwise comparison of the laboratory values showed a significant inter-laboratory difference (p<0.05). CONCLUSIONS Results clearly demonstrate, for the first time, that liver allocation for LT in Germany is based on nationwide noncomparable laboratory readouts for the MELD score.
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Mohammed
authors: M
authors: Al-Saeedi
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Taha
authors: T
authors: Yassein
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Daniel
authors: D
authors: Schultze
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Arash
authors: A
authors: Nickkholgh
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Helge
authors: H
authors: Bruns
authors: Department of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors: Markus
authors: M
authors: Zorn
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Ulf
authors: U
authors: Hinz
authors: Department of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors: Tom M
authors: TM
authors: Ganten
authors: Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors: Peter
authors: P
authors: Schemmer
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D058625:End Stage Liver Disease / Q000097:blood* / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D019934:International Normalized Ratio; D007753:Laboratories; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement; D014850:Waiting Lists
chemical_list: D003404:Creatinine; D001663:Bilirubin