Delta MELD is a significant predictor for the first year survival rate after liver transplantation

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Delta MELD is a significant predictor for the
first year survival rate after liver
transplantation

• Silberhumer G, Hetz H, Rockenschaub S,
  Bodingbauer M, Soliman T, Berlakovich G,
  Steininger R, Mühlbacher F
• Medical University of Vienna, Department for
  Transplantation

gerd.silberhumer_at_meduniwien.ac.at
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MELD literature

• ? Change of MELD Score is an independent
  predictor for death on the LTX waiting list.
• Merion et al, Liver Transplantation 2003912-18
• ? Current MELD is the single most important
  determinant. Delta MELD is predictive for death
  only within 4 d of the event.
  Bambha et al, American J of Transplantation
  200441798-1804
• ? Delta-MELD is not predictive for post
  transplant mortality.
• Northup et al, American J of Transplantation
  200441643-1649

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Patients and Methods

• Exclusion of acute liver failure, malignancy and
  retransplantation
• 298 LTX from 01/1997 to 12/2003
• Indications
• Alcoholic cirrhosis 151 patients
• Hepatitis C in 70 patients
• Hepatitis B in 10 patients
• Cholestatic cirrhosis in 26 patients
• Other reasons in 41 patients

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Allocation and MELD

• Eurotransplant, primarily local organ allocation
• Allocation based on waiting time and blood group.
• MELD Scores were calculated at time of listing
  (MELD ON) and at time of transplantation (MELD
  TX)
• DELTA-MELD MELD TX MELD ON
• Mean follow-up of 1263 days (1y 100 2y 87
  3y 78)

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Evolution of MELD Scores
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DELTA-MELD Classification
Patients with a delta-MELD lt -3 or gt4 represent
the 10th and 90th percentile of our study
population.
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Death in depending on Delta-MELD
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Survival depending on Delta-MELD
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Conclusions

• Delta-MELD is a significant predictor for post
  transplant survival.
• Delta-MELD is independent from the absolute MELD
  score at the time of transplantation.
• Hazard ratio for post transplant death was 1.08
  per unit change of delta-MELD
• Delta-MELD lt-3 91.7 1y survival vs.
• delta-MELD gt4 69.7 1y survival.

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Discussion

• Reasons of MELD-Increase?
• Treatment of waiting list complications!
• Temporary hold strategy
• Death on waiting list / post-OLT survival
  rates ??
• optimized organ use

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Discussion

• Search for reversible reasons of MELD-Increase
• Treatment of waiting list complications
• Temporary hold strategy