We recently showed that patients with a recent sudden MELD increase of >30% over 7 days (MELD spike) have higher waitlist mortality than patients with stable MELD, but lower allocation priority. Concerns were subsequently raised that patients with MELD spike might not benefit as much from LT as those without a spike (and, as such, with higher priority). We sought to quantify the survival benefit of LT for these patients.

Methods: We identified 2,984 adult liver recipients with MELD spike between 2002-2015 from SRTR. Patients with exception or Status-1 were excluded. For recipients with MELD spike, we conducted 1:3 matching based on current MELD, diagnosis, ABO, age, gender, and race among three control groups, respectively: 32,659 waitlist candidates with spike, 30,949 recipients without spike, and 85,570 candidates without spike. We used Cox regression to compare mortality risk. We calculated life years gained (over 10 yr) from LT by comparing mortality between recipients and candidates (Figure 1).

Results: Candidates with spike had 19% higher waitlist mortality risk than those without spike (HR=_1.141.19_1.25, p<0.001). However, their post-transplant mortality was comparable (HR=_0.951.02_1.10, p=0.6). Overall, LT provided 4.65 life years for patients with spike and 4.59 life years for patients without spike. Stratifying by MELD strata (Figure 2), patients with higher current MELD had more life years gained from LT. The life years gained were similar between patients with and without MELD spike across current MELD.

Conclusions: Liver candidates with MELD spike had higher mortality risk than their counterparts with the same current MELD. Their survival benefit from LT was comparable. Decreased waitlist priority for patients with a MELD spike is unjustified.

CITATION INFORMATION: Luo X, Massie A, Segev D. Survival Benefit of Liver Transplantation for Patients with MELD Spike. Am J Transplant. 2017;17 (suppl 3).

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