A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras

Authors

  • F. Kanwal,

    1. VA Greater Los Angeles Health Care System, Divisions of Gastroenterology/Hepatology and General Internal Medicine/Health Services Research, Los Angeles, CA, USA
    2. David Geffen School of Medicine at UCLA
    3. Center for the Study of Digestive Healthcare Quality and Outcomes
    4. UCLA Center for the Health Sciences
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  • G. S. Dulai,

    1. VA Greater Los Angeles Health Care System, Divisions of Gastroenterology/Hepatology and General Internal Medicine/Health Services Research, Los Angeles, CA, USA
    2. David Geffen School of Medicine at UCLA
    3. CURE Digestive Diseases Research
    4. Center for the Study of Digestive Healthcare Quality and Outcomes
    5. UCLA Center for the Health Sciences
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  • B. M. R. Spiegel,

    1. VA Greater Los Angeles Health Care System, Divisions of Gastroenterology/Hepatology and General Internal Medicine/Health Services Research, Los Angeles, CA, USA
    2. David Geffen School of Medicine at UCLA
    3. CURE Digestive Diseases Research
    4. Center for the Study of Digestive Healthcare Quality and Outcomes
    5. UCLA Center for the Health Sciences
    6. UCLA Center for Neurovisceral Sciences and Women's Health, Los Angeles, CA, USA
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  • H. F. Yee,

    1. VA Greater Los Angeles Health Care System, Divisions of Gastroenterology/Hepatology and General Internal Medicine/Health Services Research, Los Angeles, CA, USA
    2. David Geffen School of Medicine at UCLA
    3. CURE Digestive Diseases Research
    4. UCLA Center for the Health Sciences
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  • I. M. Gralnek

    1. VA Greater Los Angeles Health Care System, Divisions of Gastroenterology/Hepatology and General Internal Medicine/Health Services Research, Los Angeles, CA, USA
    2. David Geffen School of Medicine at UCLA
    3. CURE Digestive Diseases Research
    4. Center for the Study of Digestive Healthcare Quality and Outcomes
    5. UCLA Center for the Health Sciences
    6. UCLA Center for Neurovisceral Sciences and Women's Health, Los Angeles, CA, USA
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Dr I. M. Gralnek, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, 11301 Wilshire Blvd., Bldg. 115, Room 215, Los Angeles, CA 90073, USA.
E-mail: igralnek@mednet.ucla.edu

Summary

Background:  The model for end stage liver disease (MELD)-based organ allocation system is designed to prioritize orthotopic liver transplantation (OLT) for patients with the most severe liver disease. However, there are no published data to confirm whether this goal has been achieved or whether the policy has affected long-term post-OLT survival.

Aim:  To compare pre-OLT liver disease severity and long-term (1 year) post-OLT survival between the pre- and post-MELD eras.

Methods:  Using the United Network of Organ Sharing database, we compared two cohorts of adult patients undergoing cadaveric liver transplant in the pre-MELD (n = 3857) and post-MELD (n = 4245) eras. We created multivariable models to determine differences in: (i) pre-OLT liver disease severity as measured by MELD; and (ii) 1-year post-OLT outcomes.

Results:  Patients undergoing OLT in the post-MELD era had more severe liver disease at the time of transplantation (mean MELD = 20.5) vs. those in the pre-MELD era (mean MELD = 17.0). There were no differences in the unadjusted patient or graft survival at 1 year post-OLT. This difference remained insignificant after adjusting for a range of prespecified recipient, donor, and transplant centre-related factors in multivariable survival analysis.

Conclusions:  Although liver disease severity is higher in the post- vs. pre-MELD era, there has been no change in long-term post-OLT patient or graft survival. These results indicate that the MELD era has achieved its primary goals by allocating cadaveric livers to the sickest patients without compromising post-OLT survival.

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