Fifty Is the New 40? An Argument to Uncap the MELD Score.

J. DiNorcia,¹ Y. Genyk,¹ K. Andreoni,⁴ W. Kim,³ J. Levitsky,⁵ D. Mulligan,⁶ R. Sung,⁷ M. Nadim.¹

¹Univ of Southern California, Los Angeles, CA
²Stanford University, Palo Alto, CA
³Univ of Florida, Gainesville, FL
⁴Northwestern Univ, Chicago, IL
⁵Yale Univ, New Haven, CT
⁶Univ of Michigan, Ann Arbor, MI.

Meeting: 2016 American Transplant Congress

Abstract number: B246

Keywords: Allocation, Liver transplantation, Survival, Waiting lists

Session Information

Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Session

Date: Sunday, June 12, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Background: The MELD score is used to prioritize patients awaiting liver transplantation (LT) and has been capped at 40 to prevent transplant futility in patients with scores >40. However, patients with MELD>40 continue to be listed and transplanted, ranked by time on the waitlist without graded priority for MELD>40.

Methods: We analyzed the UNOS database to identify all adult patients listed for LT from February 2002 through December 2012. We evaluated waitlist and post-transplant survival stratified by MELD.

Results: Of 65,816 patients on the waitlist, 3.3% had MELD≥40 at the time of registration. A total of 48.7% underwent LT, of which 8.2% had MELD≥40 at the time of transplant. Of all patients with MELD≥40, 17% had MELD 40, 52% MELD 41-44, 24% MELD 45-49, and 6% MELD≥50. Patients transplanted with MELD≥40 increased from 6.7% to 11.3% over the study period. Region 5 transplanted 29.4% and region 7 transplanted 13.0% of all patients with MELD≥40, which accounted for 18.6% and 10.8% of LT in their region, respectively. Fifteen-day waitlist mortality increased as MELD increased, with patients MELD≥50 having the greatest risk of dying on the waitlist (Table 1). Survival benefit increased as MELD increased with MELD 45-49 (HR 0.60, 95% CI 0.37,0.98; p=0.04) and MELD≥50 (HR 0.45, 95% CI 0.24,0.82; p<0.01) having the greatest survival benefit. There was no difference in 1- and 3-year survival for patients transplanted with MELD>40 versus MELD 40.

Conclusions: Mortality on the LT waitlist significantly increases as MELD increases above 40. There is a progressively higher benefit of LT as MELD increases, and carefully selected patients transplanted with MELD>40 have 1- and 3-year survivals equivalent to patients transplanted with MELD 40. Uncapping the MELD would better align the current allocation policy with the principle of prioritizing the sickest patients and may decrease waitlist mortality.

MELD at registration	HR (95% CI)	P-value
40	1.0	<0.01
41-44	1.3 (1.01,1.6)
45-49	1.8 (1.4,2.4)
>50	2.7 (2.0,3.6)

CITATION INFORMATION: DiNorcia J, Genyk Y, Andreoni K, Kim W, Levitsky J, Mulligan D, Sung R, Nadim M. Fifty Is the New 40? An Argument to Uncap the MELD Score. Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

DiNorcia J, Genyk Y, Andreoni K, Kim W, Levitsky J, Mulligan D, Sung R, Nadim M. Fifty Is the New 40? An Argument to Uncap the MELD Score. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/fifty-is-the-new-40-an-argument-to-uncap-the-meld-score/. Accessed November 22, 2024.

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