Predictive scoring systems for mortality in heart transplant patients with liver cirrhosis

Abstract

To compare the Model for End-Stage Liver Disease (MELD), MELD-XI, and Child-Turcotte-Pugh (CTP) scores for risk prediction in patients with cirrhosis undergoing heart transplantation. This study enrolled 66 consecutive patients (26 males; median age, 46 [18-68] years) with liver cirrhosis who underwent heart transplantation at our institution from 1994 to 2022. Potential preoperative outcome predictors and the preoperative MELD, MELD-XI, and CTP scores were calculated. The median follow-up duration was 45.2 months. The MELD (p = 0.01) and MELD-XI scores (p < 0.01) were significantly different between survivors and non-survivors. Cox regression analysis showed that high MELD (hazard ratio [HR] 1.07; 95% confidence interval [CI], 1.03-1.11; p < 0.01), MELD-XI (HR, 1.16; 95% CI, 1.06-1.21; p < 0.01), and CTP scores (HR, 1.43; 95% CI, 1.20-1.75; p = 0.01) were associated with the risk of all-cause mortality. Receiver operating characteristic curve analysis revealed that the optimal cut-off values of MELD, MELD-XI, and CTP scores were 12.2, 12.0, and 7.5, respectively (sensitivity: 69.2, 61.5, and 69.2%; specificity: 68.6, 60.0, and 62.9%, respectively) for all-cause mortality (area under the curve: 0.75, 0.69, and 0.73, respectively). Patients with advanced heart failure and liver cirrhosis have high mortality and morbidity rates after heart transplantation. However, these scoring systems can be used as risk stratification tools in patients with liver cirrhosis undergoing heart transplantation.Research registration unique identifying number: Research Registry (UIN: resarchregistry10791).

Keywords: Heart transplantation; Liver cirrhosis; Liver failure.

Fig. 1

Flow diagram of the study sample selection.

Fig. 2

Kaplan–Meier survival curves in liver cirrhosis and non-liver cirrhosis groups.

Fig. 3

(A) Receiver operating characteristic curve to determine the cut-off values of scoring systems in liver cirrhosis cohorts. (B) Kaplan–Meier plots of MELD score. (C) Kaplan–Meier plots of MELD-XI score. (D) Kaplan–Meier plots of CTP score.

Fig. 4

Spline curve analysis to determine a cut-off point of scoring systems in liver cirrhosis cohorts. (A) MELD score (Akaike information criterion; AIC, 149.19 in degree of freedom; df = 1, 151.10 in df = 2, 152.99 in df 3). (B) MELD-XI score (AIC 147.18 in df = 1, 148.85 in df = 2, 150.39 in df = 3). (C) CTP score (AIC 158.2 in df = 1, 159.51 in df = 2, 159.65 in df = 3).

Fig. 5

Comparison of changes in individual scoring systems over time using Spaghetti plot after heart transplantation in patients with preexisting liver cirrhosis. Blue line: MELD score. Orange line: MELD-XI score. Grey line: CTP score.

Fig. 6

Graphic abstracts. MELD, MELD-XI, and CTP scores predict mortality risk in liver cirrhosis patients undergoing heart transplantation, with MELD-XI showing the strongest association.