The HU status is granted for acute liver failure. Patients not allocated based on lab MELD, with HU status (ie, UNOS status 1) or (non)standard exception (SE) points, listings for multiple organs (other than combined liver‐kidney), grafts from outside Eurotransplant, or missing data at listing were excluded. All patients with chronic liver disease, ≥18 years old, and registered on the Eurotransplant waiting list for a first LT between Januand Decemwere included.
The TRIPOD statement was used to report this study.ĭata were retrospectively gathered from the Eurotransplant Network Information System (ENIS) and the Eurotransplant Liver Follow‐up Registry (ELFR).
In addition, the potential effect of MELD‐Na‐based liver allocation on the Eurotransplant waiting list mortality was estimated. For this, the prediction of 90‐day WL mortality by the MELD‐Na score was investigated in the Eurotransplant population. Therefore, our aim was to validate the UNOS MELD‐Na score for the Eurotransplant region. If so, MELD‐Na‐based allocation could also lead to a reduction in WL mortality in the Eurotransplant region. We hypothesized that the serum sodium levels at listing were similar between the Eurotransplant and US regions. Therefore, MELD‐Na‐based allocation needs to be investigated in Eurotransplant before implementation. Recently, it was shown that differences in population characteristics influenced the predictive power of MELD and MELD‐Na.
However, the populations of the United States and Eurotransplant differ. Interestingly, in the UNOS regions, MELD‐Na has been used for liver graft allocation since 2016.Īfter the introduction of MELD‐Na in the United States, recent evaluation showed a decline in WL mortality. The severity of portal hypertension is inversely related to the serum Na concentration.Ĭlinically, Na levels influence the outcomes of LT candidates before and possibly even after LT. In cirrhosis, portal hypertension leads to systemic vasodilatation, secondary neurohormonal compensation and less renal excretion of solute‐free water. To improve the survival prediction and allocation by the MELD score, the addition of the serum sodium (Na) concentration was proposed, as hyponatremia is an independent prognostic factor in patients with cirrhosis. The MELD score estimates disease severity in LT candidates based on serum creatinine, bilirubin, and the International Normalized Ratio (INR) of the prothrombin time.Īdditionally, a high urgency (HU), that is, United Network for Organ Sharing (UNOS) status 1, and exception point system are used for those patients in which MELD does not adequately reflect disease severity. Since 2006, the Model for End‐stage Liver Disease (MELD) score has been used to rank and prioritize LT candidates in the Eurotransplant region. Therefore, the limited supply of donated livers should be carefully distributed.įor optimal matching and use of donor livers in the Eurotransplant (ET) region, patients are placed on a waiting list (WL) for LT. Over the past years, the prevalence and disease load of end‐stage liver disease has been increasingĪnd is estimated to triple in the next 10 years. However, the number of patients in need of LT exceeds the number of available donor grafts. Liver transplantation (LT) is the treatment of choice for end‐stage liver disease. The MELD‐Na score yielded improved prediction of 90‐day WL mortality in the ET region and using MELD‐Na for liver allocation will very likely reduce WL mortality. It was estimated that using MELD‐Na would reduce WL mortality by 4.9%. The MELD‐Na had a significantly higher c‐index of 0.847 (SE 0.007) and more accurate 90‐day mortality prediction compared to MELD (Brier score of 0.059 vs 0.061). For the 5223 included patients, the risk of 90‐day WL death was 2.9 times higher for hyponatremic patients. The reclassification from MELD to MELD‐Na score was calculated to estimate the impact of MELD‐Na‐based allocation in the ET region. The MELD‐Na performance was assessed with c‐indices, calibration per decile and Brier scores. The MELD‐corrected effect of serum sodium (Na) concentration at listing on the 90‐day WL mortality was calculated using Cox regression. All adult patients with chronic liver disease on the ET liver transplantation waiting list (WL) allocated through lab MELD scores were included. This study investigated the performance of the MELD‐Na score for the ET region. Hyponatremia in cirrhotic patients is an important predictor of death but is not incorporated in MELD. The MELD score is used in the Eurotransplant (ET) region to allocate liver grafts.
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