Pre-Operative Delta-MELD is an Independent Predictor of Higher Mortality following Liver Transplantation

George Cholankeril, Andrew A. Li, Brittany B. Dennis, Chiranjeevi Gadiparthi, Donghee Kim, Alice E. Toll, Benedict J. Maliakkal, Sanjaya Satapathy, Satheesh Nair, Aijaz Ahmed

Research output: Contribution to journalArticle

Abstract

Clinical decompensation immediately prior to liver transplantation may affect post-liver transplant (LT) outcomes. Using the serial Model for End-Stage Liver Disease (MELD) scores recorded in the United Network for Organ Sharing national registry (2010–2017), we analyzed post-LT mortality among adult LT recipients based on the degree of fluctuation in MELD score during the 30-day period prior to LT surgery. Delta-MELD (D-MELD) was defined as recipient MELD score at LT minus lowest MELD score within the preceding 30 days. Impact of D-MELD as a continuous and categorical variable (D-MELD 0–4, 5–10, >10) on early, 30-day post-LT mortality was assessed. Overall, a total of 12,785 LT recipients were analyzed, of which 8,862 (67.9%) had a pre-operative D-MELD 0–4; 2,574 (20.1%) with a D-MELD 5–10; and 1,529 (12.0%) with a D-MELD > 10. One-point incremental increase in pre-operative D-MELD (adjusted HR, 1.07, 95% CI: 1.04–1.10) was associated with higher 30-day post-LT mortality. Moreover, pre-operative D-MELD > 10 was associated with nearly a two-fold increased risk for 30-day post-LT mortality (adjusted HR, 1.89, 95% CI: 1.30–2.77) compared to D-MELD 0–4. The increased risk of pre-LT mortality associated with severity of clinical decompensation assessed by the magnitude of pre-operative D-MELD persists in the early post-LT period.

Original languageEnglish (US)
Article number8312
JournalScientific reports
Volume9
Issue number1
DOIs
StatePublished - Dec 1 2019

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End Stage Liver Disease
Liver Transplantation
Mortality
Liver
Transplants
Registries

All Science Journal Classification (ASJC) codes

  • General

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Cholankeril, G., Li, A. A., Dennis, B. B., Gadiparthi, C., Kim, D., Toll, A. E., ... Ahmed, A. (2019). Pre-Operative Delta-MELD is an Independent Predictor of Higher Mortality following Liver Transplantation. Scientific reports, 9(1), [8312]. https://doi.org/10.1038/s41598-019-44814-y

Pre-Operative Delta-MELD is an Independent Predictor of Higher Mortality following Liver Transplantation. / Cholankeril, George; Li, Andrew A.; Dennis, Brittany B.; Gadiparthi, Chiranjeevi; Kim, Donghee; Toll, Alice E.; Maliakkal, Benedict J.; Satapathy, Sanjaya; Nair, Satheesh; Ahmed, Aijaz.

In: Scientific reports, Vol. 9, No. 1, 8312, 01.12.2019.

Research output: Contribution to journalArticle

Cholankeril, G, Li, AA, Dennis, BB, Gadiparthi, C, Kim, D, Toll, AE, Maliakkal, BJ, Satapathy, S, Nair, S & Ahmed, A 2019, 'Pre-Operative Delta-MELD is an Independent Predictor of Higher Mortality following Liver Transplantation', Scientific reports, vol. 9, no. 1, 8312. https://doi.org/10.1038/s41598-019-44814-y
Cholankeril, George ; Li, Andrew A. ; Dennis, Brittany B. ; Gadiparthi, Chiranjeevi ; Kim, Donghee ; Toll, Alice E. ; Maliakkal, Benedict J. ; Satapathy, Sanjaya ; Nair, Satheesh ; Ahmed, Aijaz. / Pre-Operative Delta-MELD is an Independent Predictor of Higher Mortality following Liver Transplantation. In: Scientific reports. 2019 ; Vol. 9, No. 1.
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abstract = "Clinical decompensation immediately prior to liver transplantation may affect post-liver transplant (LT) outcomes. Using the serial Model for End-Stage Liver Disease (MELD) scores recorded in the United Network for Organ Sharing national registry (2010–2017), we analyzed post-LT mortality among adult LT recipients based on the degree of fluctuation in MELD score during the 30-day period prior to LT surgery. Delta-MELD (D-MELD) was defined as recipient MELD score at LT minus lowest MELD score within the preceding 30 days. Impact of D-MELD as a continuous and categorical variable (D-MELD 0–4, 5–10, >10) on early, 30-day post-LT mortality was assessed. Overall, a total of 12,785 LT recipients were analyzed, of which 8,862 (67.9{\%}) had a pre-operative D-MELD 0–4; 2,574 (20.1{\%}) with a D-MELD 5–10; and 1,529 (12.0{\%}) with a D-MELD > 10. One-point incremental increase in pre-operative D-MELD (adjusted HR, 1.07, 95{\%} CI: 1.04–1.10) was associated with higher 30-day post-LT mortality. Moreover, pre-operative D-MELD > 10 was associated with nearly a two-fold increased risk for 30-day post-LT mortality (adjusted HR, 1.89, 95{\%} CI: 1.30–2.77) compared to D-MELD 0–4. The increased risk of pre-LT mortality associated with severity of clinical decompensation assessed by the magnitude of pre-operative D-MELD persists in the early post-LT period.",
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AU - Li, Andrew A.

AU - Dennis, Brittany B.

AU - Gadiparthi, Chiranjeevi

AU - Kim, Donghee

AU - Toll, Alice E.

AU - Maliakkal, Benedict J.

AU - Satapathy, Sanjaya

AU - Nair, Satheesh

AU - Ahmed, Aijaz

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N2 - Clinical decompensation immediately prior to liver transplantation may affect post-liver transplant (LT) outcomes. Using the serial Model for End-Stage Liver Disease (MELD) scores recorded in the United Network for Organ Sharing national registry (2010–2017), we analyzed post-LT mortality among adult LT recipients based on the degree of fluctuation in MELD score during the 30-day period prior to LT surgery. Delta-MELD (D-MELD) was defined as recipient MELD score at LT minus lowest MELD score within the preceding 30 days. Impact of D-MELD as a continuous and categorical variable (D-MELD 0–4, 5–10, >10) on early, 30-day post-LT mortality was assessed. Overall, a total of 12,785 LT recipients were analyzed, of which 8,862 (67.9%) had a pre-operative D-MELD 0–4; 2,574 (20.1%) with a D-MELD 5–10; and 1,529 (12.0%) with a D-MELD > 10. One-point incremental increase in pre-operative D-MELD (adjusted HR, 1.07, 95% CI: 1.04–1.10) was associated with higher 30-day post-LT mortality. Moreover, pre-operative D-MELD > 10 was associated with nearly a two-fold increased risk for 30-day post-LT mortality (adjusted HR, 1.89, 95% CI: 1.30–2.77) compared to D-MELD 0–4. The increased risk of pre-LT mortality associated with severity of clinical decompensation assessed by the magnitude of pre-operative D-MELD persists in the early post-LT period.

AB - Clinical decompensation immediately prior to liver transplantation may affect post-liver transplant (LT) outcomes. Using the serial Model for End-Stage Liver Disease (MELD) scores recorded in the United Network for Organ Sharing national registry (2010–2017), we analyzed post-LT mortality among adult LT recipients based on the degree of fluctuation in MELD score during the 30-day period prior to LT surgery. Delta-MELD (D-MELD) was defined as recipient MELD score at LT minus lowest MELD score within the preceding 30 days. Impact of D-MELD as a continuous and categorical variable (D-MELD 0–4, 5–10, >10) on early, 30-day post-LT mortality was assessed. Overall, a total of 12,785 LT recipients were analyzed, of which 8,862 (67.9%) had a pre-operative D-MELD 0–4; 2,574 (20.1%) with a D-MELD 5–10; and 1,529 (12.0%) with a D-MELD > 10. One-point incremental increase in pre-operative D-MELD (adjusted HR, 1.07, 95% CI: 1.04–1.10) was associated with higher 30-day post-LT mortality. Moreover, pre-operative D-MELD > 10 was associated with nearly a two-fold increased risk for 30-day post-LT mortality (adjusted HR, 1.89, 95% CI: 1.30–2.77) compared to D-MELD 0–4. The increased risk of pre-LT mortality associated with severity of clinical decompensation assessed by the magnitude of pre-operative D-MELD persists in the early post-LT period.

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