Meld liver transplant8/27/2023 ![]() ![]() We were able to allocate organs to people who need it most,” Kim said.Ī 2016 update to the score, which was also based on work by Kim, added sodium to the formula and is known as MELDNa. “It really shuffled the waiting list, reduced the risk of waitlist mortality and increased transplants. It incorporated three common blood test values - bilirubin (a measure of liver damage), creatinine (a measure of kidney function) and the INR (international normalized ratio, a measure of blood clotting time) - to calculate a score between 6 and 40, with higher scores for sicker patients. ![]() The MELD system provided an objective way to prioritize candidates based on their predicted survival on the waitlist. “The federal government gave a mandate to the transplant medicine community to come up with an objective measure of medical urgency to allocate organs in a scientific fashion,” Kim said. Many of the sickest patients never got their turn. In the 1970s, liver transplantation was an experimental procedure, but as it evolved into an established treatment for liver disease by the 1990s, the number of people waiting for a liver began to far outpace the number of available livers, which mostly came from deceased rather than living donors. Prior to that, Kim said, liver transplants were performed on a first-come, first-served basis. Twenty years ago, as an assistant professor at the Mayo Clinic, Kim directed the team that created the original MELD score. Ray Kim, MD, professor and chief of the Division of Gastroenterology and Hepatology, led the team that developed MELD 3.0, but his history with the scoring system dates to its beginning. In June, MELD 3.0 was unanimously approved by the board of directors of the Organ Procurement and Transplantation Network, which governs the U.S. Recent concern over the accuracy of the MELD score, including a sex disparity that disadvantages women, prompted Stanford Medicine researchers and collaborators to develop a new version of the score, called MELD 3.0. The goal is to minimize waitlist deaths by moving the sickest patients to the head of the line. Placement on the list largely depends on a number called the MELD (model for end-stage liver disease) score, which estimates the short-term risk of death in patients with chronic liver disease. Finally, the effects of the MELDNa score on race or genetic ancestry were not assessed.Every year, some 13,000 people are added to the liver transplant waiting list in the United States, but fewer than 9,000 receive a liver. Also, because lab tests were not uniformly ordered, diagnostic bias could have affected the sample. ![]() Study limitations included the fact that listing and delisting dates were unavailable. Individuals with liver cancer or on dialysis were excluded. Across the entire cohort, the median age was 44 years and 57.7% were women. Most of the participants were healthy controls (n=598,409), while 601 were liver transplant patients and 24,921 had chronic liver disease but did not undergo transplant. Replication analyses were performed at the multisite NIH All of Us Research Program. "Previous studies ascribed sex differences in MELDNa scores to known sex differences in creatinine levels, but creatinine does not fully account for the sex difference in MELDNa scores," wrote Davis and colleagues.įor their study, the researchers examined EHR data on 623,931 individuals who received care at the Vanderbilt University Medical Center (VUMC) from March 2019 to April 2020. The simulated sex-adjusted model also showed a moderate reduction in deaths at 1 year compared to the OPTN model (2,480 vs 2,493), which "suggested that the sex-adjusted scores could help save lives," the researchers noted. In a proposed, sex-adjusted MELDNa scoring allocation model, slightly more women would have received a liver transplant than men (24.1% vs 23.1%) under the Organ Procurement and Transplantation Network (OPTN) MELDNa scoring, more men received transplants (23.7% vs 23.0%). "All laboratory traits used in the calculation of MELDNa scores show sex differences that increase male individuals' scores compared with female individuals', despite female individuals showing greater liver decompensation," the group concluded. Women who underwent liver transplants had more decompensation traits (mean 1.60 vs 1.34), even though they had lower MELDNa scores before transplantation (mean 20.21 vs 21.72, P=0.005 for both). And the pattern persisted regardless of whether patients were undergoing a liver transplant, had liver disease without undergoing transplant, or were healthy, according to Lea Davis, PhD, of the Vanderbilt Genetics Institute in Nashville, Tennessee, and colleagues, writing in JAMA Surgery. ![]()
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