MELD 3.0 bests MELD-Na in predicting liver transplant waitlist mortality for adolescents
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WASHINGTON — MELD 3.0 more accurately predicted the risk for 90-day waitlist mortality compared with MELD-Na among adolescent patients on a liver transplant waitlist, according to research presented at The Liver Meeting.
“Adolescents, which we have defined here as children or teenagers aged 12 to 17, constitute a unique and often overlooked waitlist cohort that is distinct from younger children and adults,” Allison J. Kwong, MD, a transplant hepatologist specializing in chronic liver disease at Stanford University, said. “They make up a sizable chunk of the pediatric transplant activity, a quarter of new waitlist registrations and liver transplant recipients.”
Previously validated in an adult population with chronic liver disease, MELD 3.0 incorporates sex and albumin as additional scoring variables, improving upon MELD-Na.
To evaluate the predictive performance of MELD-Na vs. MELD 3.0 on the risk for 90-day waitlist mortality among adolescents, Kwong and colleagues analyzed 1,315 liver transplant candidates aged 12 to 17 years and 1,856 liver transplant candidates aged 18 to 25 years who were new registrants to the waitlist from Nov. 2004 to Dec. 2021.
As differences in muscle mass and creatine between sexes are not established in adolescents aged 12 to 17 years, researchers granted these patients 1.33 points as proposed by the Organ Procurement and Transplantation Network. Performance was predicted using a time-dependent concordance (c) statistic and estimated survival using Kaplan-Meier methods as well as Cox regression.
According to results, patients in the younger cohort had lower median MELD-Na (14 vs. 18) and MELD-3.0 scores (16 vs. 19) at listing compared with the older patient cohort. In addition, 90-day survival was 97.1% vs. 95.3%, respectively.
Cox regression showed MELD 3.0 correlated with an increased hazard of mortality (HR = 1.23; 95% CI, 1.17-1.28) in adolescents. Between MELD scoring modalities, the c-statistic for 90-day waitlist survival was 0.911 using MELD 3.0 and 0.891 using MELD-Na among those aged 12 to 17 years.
“MELD 3.0 will be implemented for liver allocation in the United States for adults and adolescents coming in early 2023,” Kwong concluded. “This should be an effective solution not only for adults, but as we show here, for adolescents as well.”
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Kwong AJ, et al. Abstract 17: MELD 3.0 predicts waitlist mortality risk in adolescent liver transplant registrants. Presented at: The Liver Meeting; Nov. 4-8, 2022; Washington (hybrid).
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