LT candidates with ESLD, high MELD show increased waitlist mortality

SAN FRANCISCO — Patients with end-stage liver disease and a MELD score greater than 40 had an increased waitlist mortality rate compared with patients listed with status 1A fulminant hepatic failure, according to a plenary presentation at The Liver Meeting 2015.

Joseph C. Ahn, from the University of California, San Francisco, and colleagues performed a retrospective study of data of 15,049 adults with end-stage liver disease (ESLD) listed for liver transplant (LT) in the United Network for Organ Sharing registry from January 2003 to December 2013 and were divided into three groups based on MELD scores: 31-35, 36-40 and greater than 40. These patients were then compared with 3,049 patients waitlisted for LT with status 1A fulminant hepatic failure (FHF).

“The overall waitlist mortality and probability of LT were stratified by ESLD vs. status 1A FHF and evaluated with Kaplan Meier curves and multivariate logistic regression models,” Ahn said during his presentation.

Overall, patients with ESLD with a MELD score between 31 and 35 and MELD score between 36 and 40 had higher 28-day waitlist survival compared with patients with status 1A FHF. However, patients with a MELD score greater than 40 had similar 28-day survival.

The overall probability of LT was similar among ESLD patients with a MELD score between 36 and 40 and MELD score greater than 40 compared with patients with status 1A FHF.

Multivariate regression analysis showed that patients with ESLD with MELD scores greater than 40 had a higher 14-day waitlist mortality compared with patients with status 1A FHF (OR = 1.92; 95% CI, 1.56-2.36).

Univariate analysis showed no significant difference in probability of LT within 14 days between the two groups (OR = 1.01; 95% CI 0.88-1.16; P = .89).

Despite multiple strengths of the study, including analyzing all U.S. liver transplant patients and the use of the post-MELD era (2003-2013) for the study period, some limitations still remained, according to Ahn.

“MELD scores are dynamic and vary with disease progression. … and the etiology of liver disease in FHF does impact progression and we did not distinguish between the different etiologies,” Ahn said.

Ahn concluded: “Among U.S. adults awaiting LT, ESLD patients with MELD greater than 40 have significantly higher waitlist mortality compared to status 1A FHF patients. Despite having waitlist mortality nearly twice that of status 1A patients, ESLD patients with MELD greater than 40 have similar probability of receiving LT, compared to status 1A FHF patients. More research is needed to better define a safe, effective and equitable modification that better achieves the principles of the Final Rule.” – by Melinda Stevens

Reference:

Bhuket T, et al. Abstract 7. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: Ahn reports no relevant financial disclosures. Please see the abstract for a full list of all other author’s relevant financial disclosures.