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 23 April 2018

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News

Mortality among patients on the liver-transplant waiting list

MELD score and serum sodium concentration are important predictors of survival in patients waiting for a liver transplant, finds an article in the New England Journal of Medicine.

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Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death.

In this study, Dr W Ray Kim and colleagues evaluated candidates for liver transplantation who were registered with the Organ Procurement and Transplantation Network between 2005 and 2006.

The research team developed and validated a multivariable survival model to predict mortality at 90 days after registration. The predictor variable was the Model for End-Stage Liver Disease (MELD) score with and without the addition of the serum sodium concentration.

In 2005, there were 6769 patients waiting for liver transplantation; 1781 underwent transplantation and 422 died within 90 days of registration.

MELD score and serum sodium concentration were associated with mortality.
New England Journal of Medicine

The researchers found that both the MELD score and the serum sodium concentration were significantly associated with mortality.

The team also identified a significant interaction between MELD score and serum sodium concentration; indicating that the effect of serum sodium concentration was greater in patients with a low MELD score.

When applied to data from 2006, the team found that the combination of MELD score and serum sodium concentration was considerably higher than MELD score alone in 32 patients who died. The researchers suggest that assignment of priority according to MELD score and serum sodium concentration might have resulted in transplantation in these patients.

Dr Kim’s team concluded, “This population-wide study shows that the MELD score and the serum sodium concentration are important predictors of survival among candidates for liver transplantation”.

N Engl J Med 2008; 359(10): 1018-26

08 September 2008

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