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MELD as a Predictor of Post-Transplant Survival

X. Luo, A. Massie, A. Poon, D. Segev.

Department of Surgery, Johns Hopkins, Baltimore.

Meeting: 2015 American Transplant Congress

Abstract number: C102

Keywords: Liver transplantation, Survival

Session Information

Session Name: Poster Session C: Liver Donation and Allocation

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

 Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

MELD is a reliable tool to predict liver waitlist mortality. Previous studies of MELD and post-transplant outcomes have had conflicting results.

METHODS: We used generalized gamma regression and SRTR data 2006-2013 to explore the association between MELD at transplant and post-transplant survival, adjusting for donor, recipient and graft characteristics. Pediatric patients, multi-organ recipients, exception patients, Status 1 patients, and patients with MELD<9 were excluded.

RESULTS: Of 20,579 eligible recipients, unadjusted 5-year patient survival was 21.5%, 25.6%, and 29.7% among MELD 9-20, 21-29, and 30-40, respectively (Figure 1).

After adjustment, mortality risk was highest just after transplant and dropped down dramatically within the first year (Figure 2). After first year, mortality risk attenuated over time.

Compared to MELD 15, the adjusted relative hazard (aRH) was highest just after transplant and attenuated over time (Table 1). For example, at MELD 25, aRH was 1.37 1.54 1.78 just after transplant, but 1.06 1.20 1.32 three years post-transplant. At 5 years post-transplant, aRH was non-significant.

Table 1. Adjusted relative hazard of post-transplant mortality
  At transplant 1 year 3 years 5 years
MELD 15 Reference Reference Reference Reference
MELD 20 1.18 1.25 1.36 1.09 1.14 1.18 1.04 1.10 1.15 1.00 1.07 1.13
MELD 25 1.37 1.54 1.78 1.18 1.29 1.40 1.06 1.20 1.32 0.99 1.14 1.27
MELD 30 1.60 1.90 2.30 1.26 1.46 1.67 1.06 1.29 1.50 0.96 1.19 1.42
MELD 35 1.94 2.42 3.00 1.32 1.64 1.98 1.04 1.36 1.70 0.91 1.22 1.56
MELD 40 2.48 3.17 4.07 1.36 1.80 2.31 1.00 1.40 1.87 0.85 1.23 1.67

CONCLUSIONS: Higher MELD at transplant conferred greater risk of post-transplant mortality which attenuated over time and became non-significant after 5 years.

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To cite this abstract in AMA style:

Luo X, Massie A, Poon A, Segev D. MELD as a Predictor of Post-Transplant Survival [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/meld-as-a-predictor-of-post-transplant-survival/. Accessed June 7, 2025.

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