Clinical question: How does Model for End-Stage Liver Disease (MELD) 3.0 compare to MELD-Na in regard to liver transplant waitlist mortality?
Background: The MELD-Na scoring system has been proven to be a reliable predictor of short-term survival in patients with cirrhosis and has been used to determine the order of priority for liver transplant (LT) candidates since 2016. However, there have been concerns that the utility and equitability of the MELD-Na is waning as liver disease epidemiology changes, necessitating a change to the current model to minimize waitlist mortality while addressing the sex disparity in LT recipients.
Study design: Retrospective cohort study
Setting: U.S.
Synopsis: This study used patient data from all LT candidates from 2016 to 2018 and performed univariate and multivariate analyses to extract potential predictors of waitlist survival. The main predictors incorporated into the MELD 3.0 were the addition of female sex, serum albumin, and a lowered ceiling for serum creatinine from 4.0 mg/dL to 3.0 mg/dL. MELD 3.0 was able to successfully reclassify 9% of patients who had died on the waitlist into different priority tiers while preventing 20 waitlist deaths per year.
The MELD 3.0 addresses the waitlist mortality and the ever-important issue of sex disparity in which women are significantly less likely to receive an LT than men with the same MELD scores.
Validation of MELD 3.0 in patient populations outside the U.S. would be required since MELD 3.0, like MELD and MELD-Na, was developed for the U.S. population.
Bottom line: MELD 3.0 is superior to the MELD and MELD-Na in minimizing waitlist mortality by incorporating female sex, serum albumin, and a creatinine cut-off, and addressing the existing sex disparity.
Dr. Sheikh
Citation: Kim WR, et al. MELD 3.0: The model for end-stage liver disease updated for the modern era. Gastroenterology. 2021;161(6):1887-1895.e4.
Dr. Sheikh is associate program director for the department of internal medicine and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.