MELD-Na Alterations on the Liver Transplant Waiting List and Its Impact on Listing Outcome

G. Silberhumer¹, G. Gyoeri¹, L. Baumann¹, S. Zehetmayer², T. Soliman¹, G. Berlakovich¹

¹Transplant Surgery, Medical University Vienna, Vienna, Austria, ²Statistics Department, Medical University Vienna, Vienna, Austria

Meeting: 2019 American Transplant Congress

Abstract number: C279

Keywords: Waiting lists

Session Information

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

Session Type: Poster Session

Date: Monday, June 3, 2019

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

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

Location: Hall C & D

*Purpose: Currently, MELD Score listing is state of the art for liver transplant recipients. Our department could show by our own data and confirmed by an ET- cohort that dynamic MELD deterioration (Delta MELD) during waiting time has a significant impact on postoperative survival. Aim of this study was to analyze the impact of MELD score (Delta MELD) alterations on waiting list behavior of liver transplant candidates.

*Methods: More than 42000 patients were listed in the UNOS data for a liver transplantation between 2011 to 2015. MELD-Na was calculated according to this formula MELD − Na − [0.025 × MELD × (140 − Na)] + 140(Na ranges from 125-140) Patients were analyzed according to their delisting reasons, which were defined as transplanted, still listed, died on list, too good, too sick for transplantation or other. Difference in outcome between MELD and MELD-Na were compared.

*Results: Half of the listed patients (50.1) are already transplanted, 18.6% are still actively listed, 11.5% were removed due to poor conditions, 11% died on list, 2.6% were removed due to recovery and 6.3% of patients were removed due to other reasons. MELD and MELD-Na values are shown in table 1.

MELD/MELD Na TX too good too sick died waiting ON 18.2/20.3 13.4/15.4 18.0/20.3 19.6/22.1 13.2/15.2 TX 21.6/23.4 11.1/12.5 24.6/26.1 27.3/28.9 13.5/15.1 Delta 3.3/3.0 -2.3/-2.9 6.6/5.9 7.7/6.8 0.3/-0.1 Delta max 6.6/6.7 5.8/7.0 9.2/9.0 10.7/10.1 5.4/6.5

Delta last -0.3/-0.3. -0.4/-0.6 1.9/1.6. 2.4/2.0 -0.0/-0.1

*Conclusions: Dynamic alterations in the MELD/MELD-Na during waiting time have significant impact on waiting list behavior for liver transplant candidates. Patients finally receiving a graft showed lower listing MELD scores /MELD-Na and an only minimal increase during waiting time. In contrast patients who died on list presented with significantly higher listing MELD/MELD-Na and showed a significant deterioration during their waiting time. Patients who died on list had a significantly higher Delta Max as well a Delta compared to the other groups.

To cite this abstract in AMA style:

Silberhumer G, Gyoeri G, Baumann L, Zehetmayer S, Soliman T, Berlakovich G. MELD-Na Alterations on the Liver Transplant Waiting List and Its Impact on Listing Outcome [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/meld-na-alterations-on-the-liver-transplant-waiting-list-and-its-impact-on-listing-outcome/. Accessed May 5, 2025.

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