ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

The Predictive Power of MELD is Decreasing in the Era of Older, Sicker Patients

E. Godfrey,1 J. Lai,2 T. Miloh,3 N. Galvan,1 R. Cotton,1 C. O'Mahony,1 J. Vierling,1 N. Sussman,1 A. Rana.1

1Department of Surgery, Baylor College of Medicine, Houston, TX
2Department of Medicine, University of California, San Francisco, San Francisco, CA
3Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Meeting: 2018 American Transplant Congress

Abstract number: 351

Keywords: Allocation, Liver, Prediction models, Waiting lists

Session Information

Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues - 1

Session Type: Concurrent Session

Date: Monday, June 4, 2018

Session Time: 4:30pm-6:00pm

 Presentation Time: 4:30pm-4:42pm

Location: Room 6B

Purpose

The field of liver transplantation has shifted considerably in the MELD era. Liver allocation, immunosuppression, and etiologies of liver failure have changed over time, and better supportive therapies enable sicker patients to receive transplants. Our aim was to evaluate predictive accuracy of the MELD score over time.

Methods

The United Network for Organ Sharing provided de-identified data on 120,156 patients listed for liver transplant from 2002-2016. Candidates were categorized by age, MELD score, HCV status, and time of listing. The ability of MELD to predict 90-day mortality was evaluated by a concordance (C-) statistic.

Results

The ability of MELD to predict 90-day mortality has trended down from 0.80 in 2003 to 0.70 in 2014. Percent of waitlisted patients transplanted declined from 49% in 2005 to 30% in 2016. While lab MELD scores at listing and transplant climbed in that same interval, score at death for patients that die on the waitlist remained steady at 28. Patient ages increased from 50 to 55 years. HCV-positive status at listing dropped from 35 to 22%. The concordance of MELD and mortality does not differ with age (>60 = 0.744, < 60 = 0.747) but is higher in HCV-positive patients (HCV positive= 0.76; negative = 0.74).

Conclusions

While MELD remains predictive of mortality, its accuracy has decreased since 2002; decreasing rate of HCV infection in listed individuals may contribute to this effect. The waitlist population has steadily increased in age and liver disease severity since 2002, and a smaller proportion of listed individuals receive transplants.

CITATION INFORMATION: Godfrey E., Lai J., Miloh T., Galvan N., Cotton R., O'Mahony C., Vierling J., Sussman N., Rana A. The Predictive Power of MELD is Decreasing in the Era of Older, Sicker Patients Am J Transplant. 2017;17 (suppl 3).

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

To cite this abstract in AMA style:

Godfrey E, Lai J, Miloh T, Galvan N, Cotton R, O'Mahony C, Vierling J, Sussman N, Rana A. The Predictive Power of MELD is Decreasing in the Era of Older, Sicker Patients [abstract]. https://atcmeetingabstracts.com/abstract/the-predictive-power-of-meld-is-decreasing-in-the-era-of-older-sicker-patients/. Accessed June 6, 2025.

« Back to 2018 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences