(147) - MELD-XI Score Predicts Early and Late Mortality in Patients Following Heart Transplantation

Abstract

Purpose: The Model for End-stage Liver Disease eXcluding INR (MELD-XI) score has been validated as an accurate predictor of outcomes in heart failure patients, but its utility in orthotopic heart transplant (OHT) recipients is unknown. Accordingly, we sought to determine the risk-adjusted influence of an elevated MELD-XI score on early and late mortality following OHT. Methods: The United Network for Organ Sharing database was queried for adult (> 18 years) patients undergoing OHT between 2002 and 2012. A MELD-XI score (incorporating serum creatinine and bilirubin) was calculated. Stratification into “high” and “low” MELD-XI cohorts based on a previously established threshold score of 17 was performed. Patient specific characteristics, intraoperative variables and postoperative outcomes were compared between the two cohorts. Thirty-day, 1-year and 5-year multivariable Cox hazard regression models were constructed to determine the risk-adjusted impact of a “high” MELD-XI score on mortality. Kaplan Meier estimates were utilized to compare unadjusted survival. Results: Of the 27,126 patients that met criteria for inclusion, 22% (6,048) had MELD-XI scores > 17. Thirty-day (p< 0.001), 1-year (p< 0.001) and 5-year (p< 0.001) survival was statistically different between the score cohorts. Additionally, a “high” MELD-XI score was an independent predictor of 30-day (HR: 1.75, CI: 1.52-2.02; p< 0.001), 1-year (HR: 1.62, CI: 1.48-1.77; p< 0.001) and 5-year (HR: 1.33, CI: 1.25-1.43; p< 0.001) mortality after adjustment with a combination of recipient, donor and transplant specific variables. This cohort also experienced an increased incidence of postoperative renal failure (11.7% v. 6.5%; p< 0.001) and stroke (3.3% v. 2.2%; p< 0.001). Conclusion: This is the largest known study demonstrating the unique application of the MELD-XI scoring system in predicting early and late mortality in patients following OHT. The MELD-XI provides another preoperative metric to improve patient selection and, thus, optimize organ allocation.