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Comparative Study
. 2016:2016:1329532.
doi: 10.1155/2016/1329532. Epub 2016 Apr 3.

Validation of the Model of End-Stage Liver Disease for Liver Transplant Allocation in Alberta: Implications for Future Directions in Canada

Kelly W Burak  1 , Glenda A Meeberg  2 , Robert P Myers  1 , Gordon H Fick  3 , Mark G Swain  1 , Vincent G Bain  2 , Norman M Kneteman  2 , Robert J Hilsden  3
Affiliations
Comparative Study

Validation of the Model of End-Stage Liver Disease for Liver Transplant Allocation in Alberta: Implications for Future Directions in Canada

Kelly W Burak et al. Can J Gastroenterol Hepatol. 2016.

Abstract

Background. Since 2002, the Model of End-Stage Liver Disease (MELD) has been used for allocation of liver transplants (LT) in the USA. In Canada, livers were allocated by the CanWAIT algorithm. The aim of this study was to compare the abilities of MELD, Child-Pugh (CP), and CanWAIT status to predict 3-month and 1-year mortality before LT in Canadian patients and to describe the use of MELD in Canada. Methods. Validation of MELD was performed in 320 patients listed for LT in Alberta (1998-2002). In October 2014, a survey of MELD use by Canadian LT centers was conducted. Results. Within 1 year of listing, 47 patients were removed from the waiting list (29 deaths, 18 too ill for LT). Using logistic regression, the MELD and CP were better than the CanWAIT at predicting 3-month (AUROC: 0.79, 0.78, and 0.59; p = 0.0002) and 1-year waitlist mortality (AUROC: 0.70, 0.70, and 0.55; p = 0.0023). Beginning in 2004, MELD began to be adopted by Canadian LT programs but its use was not standardized. Conclusions. Compared with the CanWAIT system, the MELD score was significantly better at predicting LT waitlist mortality. MELD-sodium (MELD-Na) has now been adopted for LT allocation in Canada.

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Figures

Figure 1
Figure 1
Number of adult cadaveric liver transplants performed per year (bars) and the mean waiting time in days (lines) for liver transplant in Alberta (1989–2014).
Figure 2
Figure 2
Flow chart of study subjects.
Figure 3
Figure 3
Receiver operating characteristic (ROC) curves for MELD, CP, and CanWAIT scores for prediction of 3-month (a) and 1-year (b) waiting list mortality.
Figure 4
Figure 4
Kaplan-Meier survival estimates of 1-year waiting list survival for different strata of MELD scores.
Figure 5
Figure 5
Percentage of adult LT in Alberta transplanted according to natural MELD versus exception points for HCC or other indications since adopting MELD based allocation.
See this image and copyright information in PMC

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