BACKGROUND: The aim of this study was to determine the utility of the Model for End-Stage Liver Disease Excluding INR (MELD-XI) in predicting early outcomes (30 days and 1 year) and late outcomes (5 years) in patients after orthotopic heart transplantation (OHT). METHODS: The United Network for Organ Sharing database was queried for all adult patients (aged ≥ 18 years) undergoing OHT from 2000 to 2012. A MELD-XI was calculated and the population stratified into score quartiles. Early and late survivals were compared among the MELD-XI cohorts. Multivariable Cox proportional hazards models were constructed to determine the capacity of MELD-XI (when modeled both as a categoric and a continuous variable) to predict 30-day, 1-year, and 5-year mortality. Conditional models were also designed to determine the effect of early mortality on long-term survival. RESULTS: A total of 22,597 patients were included for analysis. The MELD-XI cutoff scores were established as follows: low (≤ 10.5), low-intermediate (10.6 to 12.6), intermediate-high (12.7 to 16.4), and high (>16.4). The high MELD-XI cohort experienced statistically worse 30-day, 1-year, and 5-year unconditional survivals when compared with patients with low scores (p < 0.001). Similarly, a high MELD-XI score was also predictive of early and late mortality (p < 0.001) after risk adjustment. There was, however, no difference in 5-year survival between the high score and low score cohorts after accounting for 1-year deaths. Subanalysis of patients bridged to transplant with a continuous-flow left ventricular assist device demonstrated similar findings. CONCLUSIONS: This is the first known study to examine the relationship between a high MELD-XI score and outcomes in patients after OHT. Patients with hepatic or renal dysfunction before OHT should be closely monitored and aggressively optimized as early mortality appears to drive long-term outcomes.
BACKGROUND: The aim of this study was to determine the utility of the Model for End-Stage Liver Disease Excluding INR (MELD-XI) in predicting early outcomes (30 days and 1 year) and late outcomes (5 years) in patients after orthotopic heart transplantation (OHT). METHODS: The United Network for Organ Sharing database was queried for all adult patients (aged ≥ 18 years) undergoing OHT from 2000 to 2012. A MELD-XI was calculated and the population stratified into score quartiles. Early and late survivals were compared among the MELD-XI cohorts. Multivariable Cox proportional hazards models were constructed to determine the capacity of MELD-XI (when modeled both as a categoric and a continuous variable) to predict 30-day, 1-year, and 5-year mortality. Conditional models were also designed to determine the effect of early mortality on long-term survival. RESULTS: A total of 22,597 patients were included for analysis. The MELD-XI cutoff scores were established as follows: low (≤ 10.5), low-intermediate (10.6 to 12.6), intermediate-high (12.7 to 16.4), and high (>16.4). The high MELD-XI cohort experienced statistically worse 30-day, 1-year, and 5-year unconditional survivals when compared with patients with low scores (p < 0.001). Similarly, a high MELD-XI score was also predictive of early and late mortality (p < 0.001) after risk adjustment. There was, however, no difference in 5-year survival between the high score and low score cohorts after accounting for 1-year deaths. Subanalysis of patients bridged to transplant with a continuous-flow left ventricular assist device demonstrated similar findings. CONCLUSIONS: This is the first known study to examine the relationship between a high MELD-XI score and outcomes in patients after OHT. Patients with hepatic or renal dysfunction before OHT should be closely monitored and aggressively optimized as early mortality appears to drive long-term outcomes.
Authors: Lauren K Truby; Lakshmi Sridharan; Raul J Flores; A Reshad Garan; Douglas Jennings; Melana Yuzefpolskaya; Koji Takeda; Hiroo Takayama; Yoshifumi Naka; Paolo C Colombo; Veli K Topkara Journal: ASAIO J Date: 2019 Mar/Apr Impact factor: 2.872
Authors: Kyle Freischlag; Brian Ezekian; Paul M Schroder; Michael S Mulvihill; Morgan L Cox; Matthew G Hartwig; Stuart Knechtle Journal: Transplantation Date: 2019-08 Impact factor: 4.939
Authors: Alia Dani; Justin S Heidel; Tingting Qiu; Yin Zhang; Yizhao Ni; Md Monir Hossain; Clifford Chin; David L S Morales; Bin Huang; Farhan Zafar Journal: Pediatr Transplant Date: 2021-12-08
Authors: Bernhard Wernly; Michael Lichtenauer; Marcus Franz; Bjoern Kabisch; Johanna Muessig; Maryna Masyuk; Uta C Hoppe; Malte Kelm; Christian Jung Journal: PLoS One Date: 2017-02-02 Impact factor: 3.240
Authors: A Justin Rucker; Kevin L Anderson; Michael S Mulvihill; Babatunde A Yerokun; Andrew S Barbas; Matthew G Hartwig Journal: Transplant Direct Date: 2018-12-19