2010 - TTS International Congress


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Organ Donation and Allocation I

88.2 - Comparison of Model for End-Stage liver disease (MELD) & United Kingdom End-Stage Liver Disease (UKELD) scores as a predictor for death on the liver transplant waiting list and as a predictor of mortality following liver transplantation

Presenter: SOMAIAH, AROORI, Birmingham,
Authors: AROORI S., Gupta P., Gunson B., Nightingale P., Isaac J., Muiesan P., Mirza D., Mayer D., Buckels J., Bramhall S.

COMPARISON OF MODEL FOR END-STAGE LIVER DISEASE (MELD) & UNITED KINGDOM END-STAGE LIVER DISEASE (UKELD) SCORES AS A PREDICTOR FOR DEATH ON THE LIVER TRANSPLANT WAITING LIST AND AS A PREDICTOR OF MORTALITY FOLLOWING LIVER TRANSPLANTATION

ORGAN DONATION AND ALLOCATION I

S. Aroori1, P. Gupta1, B. Gunson2, P. Nightingale3, J. Isaac2, P. Muiesan4, D. Mirza2, D. Mayer2, J. Buckels2, S. Bramhall2
1Hpb And Liver Transplantation Unit, Queen Elizabeth Hospital, Birmingham/UNITED KINGDOM, 2Hpb And Liver Transplantation, Queen Elizabeth Hospital, BIRMINGHAM/UNITED KINGDOM, 3Biostatistics, University of Birmingham, Birmingham/UNITED KINGDOM, 4Hpb And Liver Transplantation, Queen Elizabeth Hospital, Birmingham/UNITED KINGDOM

Body: Introduction: Model for End-Stage liver disease (MELD) scoring system is used to predict the morality among patients on the waiting list (WL) for liver transplantation (LT). Several studies have shown that the addition of serum sodium to MELD is superior to MELD alone in predicting the WL mortality. In the United Kingdom, the allocation of donor livers is based on MELD and United Kingdom End-Stage Liver Disease (UKELD) scoring system that incorporates serum sodium. A minimum UKELD of 49 is necessary to meet the criteria for listing on LT waiting list. Aims: The aim of this study was to evaluate the predictive accuracy of MELD and UKELD in predicting the WL mortality and post-liver transplant mortality. Material and Methods: This is retrospective analysis of prospectively collected data of 524 consecutive patients (median age (range): 53 (18-72) yrs, Males 332) with end-stage liver disease added onto the LT waiting list between October 2005 and 31 December 2009 at out centre. Patients who were listed as super urgent were excluded from the study. MELD and UKELD scores were calculated based on the serum creatinine, Bilirubin, and International normalised ratio (INR) and serum sodium levels at the time of listing and just before or the day of the transplantation. Patients with hepatocellular carcinoma (HCC) were given a MELD score of 20 if their original MELD was less than 20. UKELD score was calculated based on the following formula: 5 x {1.5 x ln(INR) + 0.3 x ln(Creat) + 0.6 x ln(Br) - 13 x ln (Na) + 70}. Results: Out of 524 patients, 370 underwent LT, 73 died while on the WL, 54 are still on the WL, seven were removed from WL due to progression of HCC, five refused transplant, and 15 were removed from WL for other reasons.The overall WL mortality was 15.3%.The median waiting time for the LT was 81.5 days (range: 1-1196). MELD and UKELD scores at the time of listing were 17 (range: 6-37) and 53 (range: 26-73) respectively. The MELD and UKELD at the time of LT was 19 (range: 6-49) and 53 (range: 40-79) respectively. Cox regression analysis showed that UKELD was more accurate in predicting the WL mortality (odds ratio (OR) 7.68, P=0.001) than MELD (OR: 1.83, P=0.008). Similarly, UKELD at the time of LT was also better in predicting the post LT mortality (OR: 3.23, p=0.013) than MELD (OR: 1.9, p=0.06). Concordance statistic (c-statistic) value for UKELD was 0.89 compared to 0.66 for the MELD in predicting the mortality on the WL. The c-statistic value for UKELD was 0.78 compared to 0.65 for the MELD in predicting the post LT mortality. Conclusions: UKELD is better in predicting the waiting list mortality and post-LT mortality than MELD.

Disclosure: All authors have declared no conflicts of interest.


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