MELD score measured day 10 after orthotopic liver transplantation predicts death and re-transplantation within the first year

Abstract

Objective: The impact of early allograft dysfunction on the outcome after liver transplantation is yet to be established. We explored the independent predictive value of the Model for End-Stage Liver Disease (MELD) score measured in the post-transplant period on the risk of mortality or re-transplantation.

Material and methods: Retrospective cohort study on adults undergoing orthotopic deceased donor liver transplantation from 2004 to 2014. The MELD score was determined prior to transplantation and daily until 21 days after. The risk of mortality or re-transplantation within the first year was assessed according to quartiles of MELD using unadjusted and adjusted stepwise Cox regression analysis.

Results: We included 374 consecutive liver transplant recipients of whom 60 patients died or were re-transplanted. The pre-transplant MELD score was comparable between patients with good and poor outcome, but from day 1 the MELD score significantly diversified and was higher in the poor outcome group (MELD score quartile 4 versus quartile 1–3 at day 10: HR 5.1, 95% CI: 2.8–9.0). This association remained after adjustment for non-identical blood type, autoimmune liver disease and hepatocellular carcinoma (adjusted HR 5.3, 95% CI: 2.9–9.5 for MELD scores at day 10). The post-transplant MELD score was not associated with pre-transplant MELD score or the Eurotransplant donor risk index.

Conclusion: Early determination of the MELD score as an indicator of early allograft dysfunction after liver transplantation was a strong independent predictor of mortality or re-transplantation and was not influenced by the quality of the donor, or preoperative recipient risk factors.

Keywords:

• Alanine transaminase
• bilirubin
• creatinine
• graft survival
• international normalized ratio
• liver transplantation
• mortality
• postoperative complications
• retrospective studies

Acknowledgements

We would like to thank the MATCH steering committee and the PERSIMUNE executive committee for contributing with data for this study. Furthermore, we thank Jesper Qvist Thomassen from the department of Clinical Biochemistry at Rigshospitalet for extracting biochemical test results and for quality ascertainment of the data.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding information

Funding was obtained from the Research council at Rigshospitalet, University of Copenhagen and from the Danish National Research Foundation [Grant 126].