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. 2024 Sep 28;13(19):5816.
doi: 10.3390/jcm13195816.

Postoperative, but Not Preoperative, MELD-3.0 Prognosticates 3-Month Procedural Success in Patients Undergoing Orthotopic Heart Transplantation

Jakub Ptak  1 , Mateusz Sokolski  1   2   3 , Joanna Gontarczyk  4 , Roksana Mania  4 , Piotr Byszuk  4 , Dominik Krupka  4 , Paulina Makowska  4 , Magdalena Cielecka  2 , Anna Boluk  3 , Mateusz Rakowski  3 , Mateusz Wilk  4 , Maciej Bochenek  2 , Roman Przybylski  2 , Michał Zakliczyński  2
Affiliations

Postoperative, but Not Preoperative, MELD-3.0 Prognosticates 3-Month Procedural Success in Patients Undergoing Orthotopic Heart Transplantation

Jakub Ptak et al. J Clin Med. .

Abstract

Background/Objectives: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). Methods: The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. Results: The analysis included 106 patients undergoing HTx, with a median age of 53 years (44-63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5-22.7) in comparison to survivors, whose average score was 13.9 (9.5-16.4), p < 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4-17.8) vs. 12.3 (8.6-17.1), p = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05-1.30), p < 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity-67%; specificity-86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0-11.0) vs. 12 (8-20) days (p = 0.01). Conclusions: The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.

Keywords: HTx; MELD-3.0; cardio-renal syndrome; cardiohepatic syndrome; heart failure; hepatopathy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
ROC curve for MELD 3.0 scores 1 month after HTx.
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