Validation of the Early Postoperative labMELD as Predictor of Outcome After Transplantation of Extended Criteria Donor Livers
1General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
2Surgical Research Division, University Hospital Bonn, Bonn, Germany.
Meeting: 2015 American Transplant Congress
Abstract number: C101
Keywords: Graft survival, Liver transplantation, Outcome
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
Background:
Since there is no generally accepted standard definition of early allograft dysfunction (EAD) after liver transplantation, we recently suggested postoperative labMELD as predictor for outcome after liver transplantation. The aim of the present study was to validate this concept in another cohort of extended criteria donor organs.
Patients and Methods
Single center prospectively collected pre- intra- and postoperativ data (OPAL study/ 01/11 -12/13) of 116 extended criteria donor liver transplantations were utilized. For each recipient the laboratory model for end stage liver disease score (labMELD) was calculated for the first 7 postoperative days. The ability of the INR, total bilirubin, aspartate aminotransferase (AST), donor risk index (DRI), previously used definitions of EAD and the postoperative labMELD was compared to predict 90-day mortality due to graft loss after transplantation. For each parameter ROC curves were calculated and cut-off values defined by Youden indices. Characterization of predictive abilities were completed by calculation of sensitivity, specificity, positive and negative predictive values.
Results
The median DRI was 1.8 and median donor age 63.5 (28-95) years. 60.3% of recipients were male with a median age of 54 (23-68) years. Median postoperative day 1-7 peak-AST value was 1052 (194-17577) U/l. Rate of EAD was 22.4%. 2/116 (1.7%) patients were retransplanted. Three month survival was 90.5%. Out of possible predictors of the 3-month patient and graft loss (EAD, DRI and INR, S-Biliburin, AST and labMELD at different time points) labMELD on postoperative day 2 was the best predictor of the 3-month patient and graft loss (AUC of the ROC curve of 0.84). A MELD score < 23 on postoperative day 2 predicted with a specifity of 93.3%, sensitivity of 63.6%, positive predictive value of 50% and negative predictive value of 96% 90 day graft survival.
Conclusion
A labMELD score > 23 on postoperative day 2 was the best predictor of outcome in ECD donor liver transplantation. Routine evaluation of postoperative labMELD scores might be helpful in clinical decision making and should routinely be reported in clinical trials.
To cite this abstract in AMA style:
Hoyer D, Gallinat A, Minor T, Saner F, Kocabayoglu P, Treckmann J, Paul A. Validation of the Early Postoperative labMELD as Predictor of Outcome After Transplantation of Extended Criteria Donor Livers [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/validation-of-the-early-postoperative-labmeld-as-predictor-of-outcome-after-transplantation-of-extended-criteria-donor-livers/. Accessed May 17, 2025.« Back to 2015 American Transplant Congress