Hepatology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain.
Biostatistics, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.
Hepatol Commun. 2024 Jul 31;8(8). doi: 10.1097/HC9.0000000000000504. eCollection 2024 Aug 1.
MELD3.0 has been proposed to stratify patients on the liver transplant waiting list (WL) to reduce the historical disadvantage of women in accessing liver transplant. Our aim was to validate MELD3.0 in 2 unique populations.
This study is a 2-center retrospective cohort study from Toronto, Canada, and Valencia, Spain, of all adults added to the liver transplant WL between 2015 and 2019. Listing indications whose short-term survival outcome is not adequately captured by the MELD score were excluded. All patients analyzed had a minimum follow-up of 3 months after inclusion in the WL.
Six hundred nineteen patients were included; 61% were male, with a mean age of 56 years. Mean MELD at inclusion was 18.00 ± 6.88, Model for End-Stage Liver Disease Sodium (MELDNa) 19.78 ± 7.00, and MELD3.0 20.25 ± 7.22. AUC to predict 90-day mortality on the WL was 0.879 (95% CI: 0.820, 0.939) for MELD, 0.921 (95% CI: 0.876, 0.967) for MELDNa, and 0.930 (95% CI: 0.888, 0.973) for MELD3.0. MELDNa and MELD3.0 were better predictors than MELD (p = 0.055 and p = 0.024, respectively), but MELD3.0 was not statistically superior to MELDNa (p = 0.144). The same was true when stratified by sex, although the difference between MELD3.0 and MELD was only significant for women (p = 0.032), while no statistical significance was found in either sex when compared with MELDNa. In women, AUC was 0.835 (95% CI: 0.744, 0.926) for MELD, 0.873 (95% CI: 0.785, 0.961) for MELDNa, and 0.886 (95% CI: 0.803, 0.970) for MELD3.0; differences for the comparison between AUC in women versus men for all 3 scores were nonsignificant. Compared to MELD, MELD3.0 was able to reclassify 146 patients (24%), the majority of whom belonged to the MELD 10-19 interval. Compared to MELDNa, it reclassified 68 patients (11%), most of them in the MELDNa 20-29 category.
MELD3.0 has been validated in centers with significant heterogeneity and offers the highest mortality prediction for women on the WL without disadvantaging men. However, in these cohorts, it was not superior to MELDNa.
MELD3.0 已被提议用于对肝移植等候名单（WL）上的患者进行分层，以减少女性在接受肝移植方面的历史劣势。我们的目的是在 2 个独特的人群中验证 MELD3.0。
这是一项来自加拿大多伦多和西班牙巴伦西亚的 2 个中心的回顾性队列研究，纳入了 2015 年至 2019 年间加入肝移植 WL 的所有成年人。排除了短期生存结果不能被 MELD 评分充分捕捉的列入标准。所有分析的患者在 WL 中纳入后至少有 3 个月的随访。
共纳入 619 例患者；61%为男性，平均年龄 56 岁。纳入时的平均 MELD 为 18.00±6.88，模型终末期肝病钠（MELDNa）为 19.78±7.00，MELD3.0 为 20.25±7.22。预测 WL 上 90 天死亡率的 AUC 为 MELD 为 0.879（95%CI：0.820，0.939），MELDNa 为 0.921（95%CI：0.876，0.967），MELD3.0 为 0.930（95%CI：0.888，0.973）。MELDNa 和 MELD3.0 均优于 MELD（p=0.055 和 p=0.024），但 MELD3.0 与 MELDNa 相比并不具有统计学优势（p=0.144）。按性别分层也是如此，尽管 MELD3.0 与 MELD 之间的差异仅在女性中具有统计学意义（p=0.032），而在男性中与 MELDNa 相比则没有统计学意义。在女性中，AUC 为 MELD 为 0.835（95%CI：0.744，0.926），MELDNa 为 0.873（95%CI：0.785，0.961），MELD3.0 为 0.886（95%CI：0.803，0.970）；在所有 3 项评分中，女性与男性 AUC 之间的比较差异均无统计学意义。与 MELD 相比，MELD3.0 能够重新分类 146 例患者（24%），其中大多数属于 MELD 10-19 区间。与 MELDNa 相比，它重新分类了 68 例患者（11%），其中大多数属于 MELDNa 20-29 类别。
MELD3.0 在具有显著异质性的中心得到了验证，可为 WL 上的女性提供最高的死亡率预测，而不会使男性处于不利地位。然而，在这些队列中，它并不优于 MELDNa。
