Aims

Living donor liver transplantation (LDLT) is an underutilized resource. Timely identification of patients with cirrhosis and a low MELD who's MELD score is likely to increase over time may result in earlier referral for LDLT. Our aim was to identify factors most associated with an increase in MELD score over time using a large population database as previous studies addressing the problem have been largely limited to transplant registry data.

Methods

HealthLNK captures electronic medical record data for over 2 million patients treated within 6 diverse healthcare integrated networks in the greater Chicago area (Northwestern Medicine, Univ of Chicago, Rush Univ MC, University of Illinois of Chicago MC, Loyola Univ MC and Cook County Health Systems) between 2006 and 2012. HealthLNK data was merged with UNOS and death registry data. Patients with cirrhosis were identified by ICD9 (571.2, 571.5, 571.6) and Fib-4 scores. MELD scores were calculated and demographics were collected. A low MELD cohort was identified whose MELD score was never ≥15 during the study period. Another cohort was identified who's MELD score increased over time from<15 to ≥15. A multivariate logistic regression model was fitted using stepwise selection and adjusting for age gender and race to identify factors associated with MELD progression.

Results

A cohort of 9880 patients with cirrhosis were identified.6928 had an initial MELD <15 and 2952 had a high MELD. Of those with a low MELD 1982 progressed to MELD ≥15 while 4946 never had a MELD score ≥15. Median fu was 38mo (min 0.6, max 83). The low vs low to high MELD group were 62 vs 64 yrs, 53% vs 60% male, 61% vs 65% white, etiology of cirrhosis was consider ETOH 23% vs 35%, NASH 19% vs 21% and HCV 37% vs 38%. An increased risk of MELD progression was seen for patients with malnutrition (OR=4.6;95%CI 3.9,5.5), hyponatremia (OR=2.3;95%CI 2.0,2.7), ascites (OR=2.1;95%CI 1.7,2.5), HE (OR=2.0;95%CI 1.8, 2.4), SBP (OR=1.7;95%CI 1.2, 2.5), fib4-score>3.25 (OR=1.7;95%CI1.4,2.0), thrombocytopenia (OR=1.6;95%CI 1.3,1.9),NASH (OR=1.5;95%CI 1.2, 1.9), and variceal bleeding (OR=1.5;95%CI 1.2,1.8).

Conclusions

A significant number of patients with cirrhosis and a low MELD will progress clinically. Those with malnutrition are at the highest risk. We have also identified other factors that may be used as criteria for early referral for specialist care including LDLT.

CITATION INFORMATION: Atiemo K, Zhao L, Skaro A, VanWagner L, Goel S, Kho A, Ho B, Kang R, Montag S, Holl J, Abecassis M, Ladner D. Factors Associated with Increased Risk of MELD Progression Among a Large Population of Patients with Cirrhosis and an Initial Low MELD Score (<15). Am J Transplant. 2016;16 (suppl 3).

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