MELD-XI score predicts early mortality in patients after heart transplantation

Joshua C. Grimm, Ashish S. Shah, J. Trent Magruder, Arman Kilic, Vicente Valero, Samuel P. Dungan, Ryan J. Tedford, Stuart D. Russell, Glenn J.R. Whitman, Christopher M. Sciortino

Research output: Contribution to journalArticlepeer-review

Abstract

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 (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.

Original languageEnglish (US)
Pages (from-to)1737-1743
Number of pages7
JournalAnnals of Thoracic Surgery
Volume100
Issue number5
DOIs
StatePublished - Nov 2015

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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