Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Nov;21(11):1403-9.
doi: 10.1002/lt.24307.

Outcomes for liver transplant candidates listed with low model for end-stage liver disease score

Allison J Kwong  1 , Jennifer C Lai  2 , Jennifer L Dodge  3 , John P Roberts  3
Affiliations

Outcomes for liver transplant candidates listed with low model for end-stage liver disease score

Allison J Kwong et al. Liver Transpl. 2015 Nov.

Abstract

The Model for End-Stage Liver Disease (MELD) score, which estimates mortality within 90 days, determines priority for liver transplantation (LT). However, longer-term outcomes on the wait list for patients who are initially listed with low MELD scores are not well characterized. All adults listed for primary LT at a single, high-volume center from 2005 to 2012 with an initial laboratory MELD score of 22 or lower were evaluated. Excluded were those patients listed with MELD exception points who underwent living donor liver transplantation (LDLT) or transplantation at another center, or who were removed from the wait list for nonmedical reasons. Outcomes and causes of death were identified by United Network for Organ Sharing, the National Death Index, and an electronic medical record review. Multivariate competing risk analysis evaluated predictors of death compared to deceased donor liver transplantation (DDLT); 893 patients were listed from 2005 to 2012. By the end of follow-up, 27% had undergone DDLT, and 31% were removed from the wait list for death or clinical deterioration. In a competing risks assessment, only MELD score of 6-9, older age, lower serum albumin, lower body mass index, and diabetes conferred an increased risk of wait-list dropout compared to DDLT. Listing for simultaneous liver-kidney transplantation was protective against wait-list dropout. Of the patients included, 275 patients died or were delisted for being too sick; 87% of the identifiable causes of death were directly related to end-stage liver disease or hepatocellular carcinoma. In conclusion, patients with low listing MELD scores remain at a significant risk for death due to liver-related causes and may benefit from early access to transplantation, such as LDLT or acceptance of high-risk donor livers. Predictors of death compared to transplantation may allow for early identification of patients who are at risk for wait-list mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Chart showing patient selection.
Figure 2
Figure 2
Cumulative probabilities of death or delisting and DDLT after listing for LT.
Figure 3
Figure 3
Identified causes of death in patients removed from the waitlist for death or being “too sick.”
See this image and copyright information in PMC

References

    1. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003 Jan;124(1):91–96. - PubMed
    1. Kim WR, Smith JM, Skeans MA, Schladt DP, Schnitzler MA, Edwards EB, et al. OPTN/SRTR 2012 Annual Data Report: liver. Am J Transplant. 2014 Jan;14(Suppl 1):69–96. - PubMed
    1. Huo TI, Lin HC, Wu JC, Hou MC, Lee FY, Lee PC, et al. Limitation of the model for end-stage liver disease for outcome prediction in patients with cirrhosis-related complications. Clin Transplant. 2006 Mar-Apr;20(2):188–194. - PubMed
    1. Biggins SW, Bambha K. MELD-based liver allocation: who is underserved? Semin Liver Dis. 2006 Aug;26(3):211–220. - PubMed
    1. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008 Sep 4;359(10):1018–1026. - PMC - PubMed

Publication types

MeSH terms