This article is more than 5 years old. Information may no longer be current.

LT priority needed for patients with MELD score greater than 40

Patients with a MELD score greater than 40 had a significantly greater liver transplantation waitlist mortality rate but comparable posttransplant survival with patients with a MELD score of 40, according to the results of a recently published study.

“The disparity between the availability of donor organs and the growing number of patients awaiting transplant is one of the greatest challenges in organ transplantation. A needs-based allocation policy prioritizes those at greatest risk of death on the waitlist while a utility-based policy prioritizes graft and patient survival,” Mitra K. Nadim, MD, from the University of Southern California, and colleagues wrote. “We hypothesized that the MELD cap of 40 disadvantages the sickest patients with ESLD and that rank ordering by calculated MELD score may decrease waitlist mortality and provide survival benefit to patients with the greatest MELD scores.”

Data were gathered from the UNOS Standard Transplant Analysis and Research File from Jan. 27, 2002, to Dec. 31, 2012. The study comprised 65,776 patients on the waitlist and 30,269 LT recipients. Median age was 53 years. Among the 2,615 patients in the “capped” population for reaching a MELD score of 40, 2,169 had MELD scores greater than 40.

Compared with patients with a MELD score of 40, relative risk for death within 30 days after LT waitlist registration increased for patients with MELD scores 41 to 44 (HR = 1.4; 95% CI, 1.-1.6), 45 to 49 (HR = 2.6; 95% CI, 2.1-3.1) and 50 or greater (HR = 5; 95% CI, 4.1-6.1).

At day 15 following initial report of MELD score 40 or greater, overall survival was 58% for patients with MELD score 40 (95% CI, 55-61), 49% for patients with MELD score 41 to 44 (95% CI, 47-52), 37% for patients with MELD score 45 to 49 (95% CI, 34-41) and 28% for patients with a MELD score of 50 or greater (95% CI, 23-34). At 30 days, overall survival rates were 33% for patients with MELD score of 40 (95% CI, 29-37), 29% for those with MELD score 41 to 44 (95% CI, 26-31), 19% for those with MELD score 45 to 59 (95% CI, 15-23), and 17% for those with MELD score 50 or greater (95% CI, 12-23).

There were no significant differences between patients with MELD score of 40 and those with a score greater than 40 for overall transplant survival rates at 1 and 3 years follow-up.

“As long as there is a shortage of donor organs, any organ allocation system will disadvantage a subgroup of patients on the waitlist for transplantation. Despite improvements in the current liver allocation system, patients with the greatest waitlist mortality do not receive appropriate priority for LT, and policy makers must critically evaluate the MELD cap at 40,” the researchers concluded. “We advocate uncapping the MELD score to allow more equitable distribution of livers and to better align the current liver allocation policy with the fundamental principle of prioritizing the patients most in need.” – by Talitha Bennett

Disclosures: The researchers report no relevant financial disclosures.