دورية أكاديمية
أعرض في EDS

Validation of MELD3.0 in 2 centers from different continents.

التفاصيل البيبلوغرافية
العنوان: Validation of MELD3.0 in 2 centers from different continents.
المؤلفون: Tejedor M; Hepatology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain., Bellón JM; Biostatistics, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.; CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Fernández de la Varga M; Hepatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Peralta P; Research, Toronto General Hospital, Toronto, Ontario, Canada., Montalvá E; Department of Hepatobiliopancreatic Surgery and Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.; Department of Medicine, University of Valencia, Valencia, Spain.; Liver and Digestive Diseases Networking Biomedical Research Centre (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain., Selzner N; Transplant Hepatology, Ajmera Transplant Center, University of Toronto, Toronto, Ontario, Canada., Berenguer M; Liver and Digestive Diseases Networking Biomedical Research Centre (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain.; Hepatology and Liver Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.; Medicine Department, University of Valencia, Valencia, Spain.
المصدر: Hepatology communications [Hepatol Commun] 2024 Jul 31; Vol. 8 (8). Date of Electronic Publication: 2024 Jul 31 (Print Publication: 2024).
نوع المنشور: Journal Article; Multicenter Study; Validation Study
اللغة: English
بيانات الدورية: Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 101695860 Publication Model: eCollection Cited Medium: Internet ISSN: 2471-254X (Electronic) Linking ISSN: 2471254X NLM ISO Abbreviation: Hepatol Commun Subsets: MEDLINE
أسماء مطبوعة: Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc.
Original Publication: [Hoboken, NJ] : Wiley Periodicals, Inc. on behalf of the American Association for the Study of Liver Diseases, [2017]-
مواضيع طبية MeSH: Liver Transplantation*/statistics & numerical data , Waiting Lists*/mortality , Severity of Illness Index* , End Stage Liver Disease*/mortality , End Stage Liver Disease*/surgery, Humans ; Female ; Male ; Middle Aged ; Retrospective Studies ; Spain ; Aged ; Adult ; Sex Factors
مستخلص: Background: MELD3.0 has been proposed to stratify patients on the liver transplant waiting list (WL) to reduce the historical disadvantage of women in accessing liver transplant. Our aim was to validate MELD3.0 in 2 unique populations.
Methods: This study is a 2-center retrospective cohort study from Toronto, Canada, and Valencia, Spain, of all adults added to the liver transplant WL between 2015 and 2019. Listing indications whose short-term survival outcome is not adequately captured by the MELD score were excluded. All patients analyzed had a minimum follow-up of 3 months after inclusion in the WL.
Results: Six hundred nineteen patients were included; 61% were male, with a mean age of 56 years. Mean MELD at inclusion was 18.00 ± 6.88, Model for End-Stage Liver Disease Sodium (MELDNa) 19.78 ± 7.00, and MELD3.0 20.25 ± 7.22. AUC to predict 90-day mortality on the WL was 0.879 (95% CI: 0.820, 0.939) for MELD, 0.921 (95% CI: 0.876, 0.967) for MELDNa, and 0.930 (95% CI: 0.888, 0.973) for MELD3.0. MELDNa and MELD3.0 were better predictors than MELD (p = 0.055 and p = 0.024, respectively), but MELD3.0 was not statistically superior to MELDNa (p = 0.144). The same was true when stratified by sex, although the difference between MELD3.0 and MELD was only significant for women (p = 0.032), while no statistical significance was found in either sex when compared with MELDNa. In women, AUC was 0.835 (95% CI: 0.744, 0.926) for MELD, 0.873 (95% CI: 0.785, 0.961) for MELDNa, and 0.886 (95% CI: 0.803, 0.970) for MELD3.0; differences for the comparison between AUC in women versus men for all 3 scores were nonsignificant. Compared to MELD, MELD3.0 was able to reclassify 146 patients (24%), the majority of whom belonged to the MELD 10-19 interval. Compared to MELDNa, it reclassified 68 patients (11%), most of them in the MELDNa 20-29 category.
Conclusions: MELD3.0 has been validated in centers with significant heterogeneity and offers the highest mortality prediction for women on the WL without disadvantaging men. However, in these cohorts, it was not superior to MELDNa.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)
References: Tejedor M, Selzner N, Berenguer M. Are MELD and MELDNa still reliable tools to predict mortality on the liver transplant waiting list? Transplantation. 2022;106:2122–2136.
Moylan CA, Brady CW, Johnson JL, Smith AD, Tuttle-Newhall JE, Muir AJ. Disparities in liver transplantation before and after introduction of the MELD score. JAMA J Am Med Assoc. 2008;300:2371–2378.
Cullaro G, Sarkar M, Lai JC. Sex-based disparities in delisting for being “too sick” for liver transplantation. Am J Transplant. 2018;18:1214–1219.
Mazumder NR, Celaj S, Atiemo K, Daud A, Jackson KL, Kho A, et al. Liver-related mortality is similar among men and women with cirrhosis. J Hepatol. 2020;73:1072–1081.
Mathur AK, Schaubel DE, Gong Q, Guidinger MK, Merion RM. Sex-based disparities in liver transplant rates in the United States. Am J Transplant. 2011;11:1435–1443.
Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SW, et al. MELD 3.0: The Model for End-Stage Liver Disease updated for the modern era. Gastroenterology. 2021;161:1887–1895.e4.
MELD calculator - OPTN. Accessed August 12, 2023. https://optn.transplant.hrsa.gov/data/allocation-calculators/meld-calculator/.
OPTN/SRTR 2019 annual data report: Liver. Accessed October 12, 2021. Liver (hrsa.gov).
Matesanz R, Domínguez-Gil B, Coll E, de la Rosa G, Marazuela R. Spanish experience as a leading country: what kind of measures were taken? Transpl Int. 2011;24:333–343.
Streit S, Johnston-Webber C, Mah J, Prionas A, Wharton G, Casanova D, et al. Ten lessons from the Spanish model of organ donation and transplantation. Transpl Int. 2023;36:11009.
Matesanz R, Domínguez-Gil B, Coll E, Mahíllo B, Marazuela R. How Spain reached 40 deceased organ donors per million population. Am J Transplant. 2017;17:1447–1454.
Yoo JJ, Chang JI, Moon JE, Sinn DH, Kim SG, Kim YS. Validation of MELD 3.0 scoring system in East Asian patients with cirrhosis awaiting liver transplantation. Liver Transpl. 2023;29:1029–1040.
Myers RP, Shaheen AAM, Aspinall AI, Quinn RR, Burak KW. Gender, renal function, and outcomes on the liver transplant waiting list: Assessment of revised MELD including estimated glomerular filtration rate. J Hepatol. 2011;54:462–470.
Allen AM, Heimbach JK, Larson JJ, Mara KC, Kim WR, Kamath PS, et al. Reduced access to liver transplantation in women: Role of height, MELD exception scores and renal function underestimation. Transplantation. 2018;102:1710–1716.
Lai JC, Terrault NA, Vittinghoff E, Biggins SW. Height contributes to the gender difference in wait-list mortality under the MELD-based liver allocation system. Am J Transplant. 2010;10:2658–2664.
Nephew LD, Goldberg DS, Lewis JD, Abt P, Bryan M, Forde KA. Exception points and body size contribute to gender disparity in liver transplantation. Clin Gastroenterol Hepatol. 2017;15:1286–1293.e2.
Mindikoglu AL, Emre SH, Magder LS. Impact of estimated liver volume and liver weight on gender disparity in liver transplantation. Liver Transpl. 2013;19:89–95.
Cholongitas E, Marelli L, Kerry A, Goodier DW, Nair D, Thomas M, et al. Female liver transplant recipients with the same GFR as male recipients have lower MELD scores—A systematic bias. Am J Transplant. 2007;7:685–692.
Rodríguez-Perálvarez ML, Gómez-Orellana AM, Majumdar A, Bailey M, McCaughan GW, Gow P, et al. Development and validation of the Gender-Equity Model for Liver Allocation (GEMA) to prioritise candidates for liver transplantation: A cohort study. Lancet Gastroenterol Hepatol. 2023;8:242–252.
Kalafateli M, Wickham F, Burniston M, Cholongitas E, Theocharidou E, Garcovich M, et al. Development and validation of a mathematical equation to estimate glomerular filtration rate in cirrhosis: The Royal Free Hospital cirrhosis glomerular filtration rate. Hepatology. 2017;65:582–591.
Godfrey EL, Malik TH, Lai JC, Mindikoglu AL, Galván NTN, Cotton RT, et al. The decreasing predictive power of MELD in an era of changing etiology of liver disease. Am J Transplant. 2019;19:3299–3307.
Asrani SK, Jennings LW, Kim WR, Kamath PS, Levitsky J, Nadim MK, et al. MELD-GRAIL-Na: Glomerular filtration rate and mortality on liver-transplant waiting list. Hepatology Baltim Md. 2020;71:1766–1774.
Goudsmit BFJ, Putter H, Tushuizen ME, de Boer J, Vogelaar S, Alwayn IPJ, et al. Validation of the Model for End‐stage Liver Disease sodium (MELD‐Na) score in the Eurotransplant region. Am J Transplant. 2021;21:229–240.
Kwong A, Mannalithara A, Kim WR. Reply to: “The decreasing predictive power of MELD in an era of changing etiology of liver disease. Am J Transplant. 2020;20:901–902.
D’Amico G, Maruzzelli L. MELD calibration. Am J Transplant. 2021;21:438–439.
تواريخ الأحداث: Date Created: 20240731 Date Completed: 20240731 Latest Revision: 20240731
رمز التحديث: 20240731
DOI: 10.1097/HC9.0000000000000504
PMID: 39082971
قاعدة البيانات: MEDLINE
الوصف
تدمد:2471-254X
DOI:10.1097/HC9.0000000000000504