Cargando…

Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List

BACKGROUND: Allocation of donor livers for transplantation in most regions is based on the Model for End-Stage Liver Disease (MELD) or MELD-sodium (MELDNa). Our objective was to assess revisions to MELD and MELDNa that include serum albumin for predicting waiting list mortality. METHODS: Adults regi...

Descripción completa

Detalles Bibliográficos
Autores principales: Myers, Robert P., Shaheen, Abdel Aziz M., Faris, Peter, Aspinall, Alexander I., Burak, Kelly W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548898/
https://www.ncbi.nlm.nih.gov/pubmed/23349678
http://dx.doi.org/10.1371/journal.pone.0051926
_version_ 1782256386357329920
author Myers, Robert P.
Shaheen, Abdel Aziz M.
Faris, Peter
Aspinall, Alexander I.
Burak, Kelly W.
author_facet Myers, Robert P.
Shaheen, Abdel Aziz M.
Faris, Peter
Aspinall, Alexander I.
Burak, Kelly W.
author_sort Myers, Robert P.
collection PubMed
description BACKGROUND: Allocation of donor livers for transplantation in most regions is based on the Model for End-Stage Liver Disease (MELD) or MELD-sodium (MELDNa). Our objective was to assess revisions to MELD and MELDNa that include serum albumin for predicting waiting list mortality. METHODS: Adults registered for liver transplantation in the United States (2002–2007) were identified from the United Network for Organ Sharing (UNOS) database. Cox regression was used to determine the association between serum albumin and 3-month mortality, and to derive revised MELD and MELDNa scores incorporating albumin (‘MELD-albumin’ and ‘5-variable MELD [5vMELD]’). RESULTS: Among 40,393 patients, 9% died and 24% underwent transplantation within 3 months of listing. For serum albumin concentrations between 1.0 and 4.0 g/dL, a linear, inverse relationship was observed between albumin and 3-month mortality (adjusted hazard ratio per 1 g/dL reduction in albumin: 1.44; 95% CI 1.35–1.54). The c-statistics for 3-month mortality of MELD-albumin and MELD were 0.913 and 0.896, respectively (P<0.001); 5vMELD was superior to MELDNa (c-statistics 0.922 vs. 0.912, P<0.001). The potential benefit of 5vMELD was greatest in patients with low MELD (<15). Among low MELD patients who died, 27% would have gained ≥10 points with 5vMELD over MELD versus only 4–7% among low MELD survivors and high MELD (≥15) candidates (P<0.0005). CONCLUSION: Modification of MELD and MELDNa to include serum albumin is associated with improved prediction of waiting list mortality. If validated and shown to be associated with reduced mortality, adoption of 5vMELD as the basis for liver allograft allocation may improve outcomes on the liver transplant waiting list.
format Online
Article
Text
id pubmed-3548898
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-35488982013-01-24 Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List Myers, Robert P. Shaheen, Abdel Aziz M. Faris, Peter Aspinall, Alexander I. Burak, Kelly W. PLoS One Research Article BACKGROUND: Allocation of donor livers for transplantation in most regions is based on the Model for End-Stage Liver Disease (MELD) or MELD-sodium (MELDNa). Our objective was to assess revisions to MELD and MELDNa that include serum albumin for predicting waiting list mortality. METHODS: Adults registered for liver transplantation in the United States (2002–2007) were identified from the United Network for Organ Sharing (UNOS) database. Cox regression was used to determine the association between serum albumin and 3-month mortality, and to derive revised MELD and MELDNa scores incorporating albumin (‘MELD-albumin’ and ‘5-variable MELD [5vMELD]’). RESULTS: Among 40,393 patients, 9% died and 24% underwent transplantation within 3 months of listing. For serum albumin concentrations between 1.0 and 4.0 g/dL, a linear, inverse relationship was observed between albumin and 3-month mortality (adjusted hazard ratio per 1 g/dL reduction in albumin: 1.44; 95% CI 1.35–1.54). The c-statistics for 3-month mortality of MELD-albumin and MELD were 0.913 and 0.896, respectively (P<0.001); 5vMELD was superior to MELDNa (c-statistics 0.922 vs. 0.912, P<0.001). The potential benefit of 5vMELD was greatest in patients with low MELD (<15). Among low MELD patients who died, 27% would have gained ≥10 points with 5vMELD over MELD versus only 4–7% among low MELD survivors and high MELD (≥15) candidates (P<0.0005). CONCLUSION: Modification of MELD and MELDNa to include serum albumin is associated with improved prediction of waiting list mortality. If validated and shown to be associated with reduced mortality, adoption of 5vMELD as the basis for liver allograft allocation may improve outcomes on the liver transplant waiting list. Public Library of Science 2013-01-18 /pmc/articles/PMC3548898/ /pubmed/23349678 http://dx.doi.org/10.1371/journal.pone.0051926 Text en © 2013 Myers et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Myers, Robert P.
Shaheen, Abdel Aziz M.
Faris, Peter
Aspinall, Alexander I.
Burak, Kelly W.
Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List
title Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List
title_full Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List
title_fullStr Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List
title_full_unstemmed Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List
title_short Revision of MELD to Include Serum Albumin Improves Prediction of Mortality on the Liver Transplant Waiting List
title_sort revision of meld to include serum albumin improves prediction of mortality on the liver transplant waiting list
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548898/
https://www.ncbi.nlm.nih.gov/pubmed/23349678
http://dx.doi.org/10.1371/journal.pone.0051926
work_keys_str_mv AT myersrobertp revisionofmeldtoincludeserumalbuminimprovespredictionofmortalityonthelivertransplantwaitinglist
AT shaheenabdelazizm revisionofmeldtoincludeserumalbuminimprovespredictionofmortalityonthelivertransplantwaitinglist
AT farispeter revisionofmeldtoincludeserumalbuminimprovespredictionofmortalityonthelivertransplantwaitinglist
AT aspinallalexanderi revisionofmeldtoincludeserumalbuminimprovespredictionofmortalityonthelivertransplantwaitinglist
AT burakkellyw revisionofmeldtoincludeserumalbuminimprovespredictionofmortalityonthelivertransplantwaitinglist