Utility of post-liver transplantation MELD and delta MELD in predicting early and late mortality

Introduction The performance of early post-liver transplantation (post-LT) model for end-stage liver disease (MELD) or even its dynamic changes over time (Delta MELD) in predicting the mortality after LT is still controversial. Aim The aim of this study was to assess the ability of absolute and Delta MELD calculated at days 7 and 30 after LT to predict 1- and 5-year mortality. Patients and methods Data of 209 consecutive patients who underwent LT in two centers were reviewed. Patients who received LT for hepatocellular carcinoma were excluded, as well as those who did not survive for at least 1 month. MELD and Delta MELD were calculated for each patient at 7 and 30 days after LT. Results One hundred fifty-six patients were included, mostly male [104 (66.7%)] with a mean age of 51.9 +/- 8.8 years. The main indications for transplantation were decompensated hepatitis C virus-related liver cirrhosis [138 (88.5%)] and hepatitis C and B virus co-infection [10 (6.4%)]. Grafts were obtained from 104 living donors and 52 deceased donors. Survival at 1 and 5 years was 89.7 and 85.9%, respectively, with a mean survival of 52.3 +/- 1.5 months. In univariate analysis, both absolute and Delta MELD at postoperative days 7 and 30 significantly predicted 1- and 5-year post-LT mortality. In multivariate analysis, MELD at postoperative day 30 was significantly associated with 1-(odds ratio: 1.24, 95% confidence interval: 1.14-1.35, P < 0.0001) and 5-year mortality (odds ratio: 1.23, 95% confidence interval: 1.14-1.33, P < 0.0001). The area under the curve for MELD at 30 days post-LT in the prediction of mortality was 0.823 (P = 0.01) at 1 year and 0.812 (P < 0.001) at 5 years. A cutoff of post-LT day 30 MELD less than 10 could predict mortality with a sensitivity and specificity of 90 and 68.1% at 1 year and 81.3 and 69.7% at 5 years, respectively. Conclusion Failure of the MELD score to decline over the first postoperative month to less than 10 is a significant predictor of both early and late post-LT mortality. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.