Since February 2002, the Model for End-Stage Liver Disease (MELD) score has been used to allocate liver allografts in the U.S. The aim of this study was to investigate if deterioration in a patient's clinical status, reflected by a rising MELD score, has an impact on post-liver transplant outcome. Furthermore, we aimed to determine if a rising MELD score is a better survival predictor than the final MELD score.

The SRTR data of all patients (≥18 years old) that underwent liver transplantation between 3/1/2002 to 12/31/2013 was investigated. Patients with re-transplants, living donor liver transplants, multi-organ transplants, and those who received exception points (e.g. cancer patients) were excluded from analysis. Cox proportion hazard model was used to determine significant variables influencing the transplant mortality rate.

The data on 31,711 transplant recipients with a mean age of 52.3 ± 10.5 years were included. Increase in MELD score ≥ 10 was found to be significant in predicting post-transplant mortality (HR 1.08, CI 1.02- 1.15). In the sickest patients (MELD 33 to 40), this impact was stronger (HR 1.14, CI 1.04- 1.25). Using change in MELD score (between the time of listing and time of transplantation) as a continuous variable, for every 1 point increase in MELD score the rate of mortality increased by 0.5% (HR 1.005, CI 1.001 – 1.008). Both the final MELD score and rate of change per month (MELD velocity) as continuous variables were not significant predictors of mortality.

Patients with rising MELD scores ≥ 10 while on the waiting list have worse outcome after liver transplantation. This finding is independent of their final MELD score. The results of this study reveal that allocating donor allografts in patients with MELD scores 33 to 40 with more stable MELD scores (alteration in MELD score < 10 while in waiting list) incur a better outcome. Prospective cohort studies needed to validate our results.

CITATION INFORMATION: Rahnemai-Azar A, Perkins J, Montenovo M, Pearson T, Bakthavatsalam R, Rayhill S, Dick A, Reyes J, Sibulesky L. Does Rising MELD Score Convey Worse Liver Transplant Outcome? Am J Transplant. 2016;16 (suppl 3).

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