Revised MELD and outcomes on the liver transplant waiting list

Revised MELD and outcomes on the liver transplant waiting list

"Women are disadvantaged under MELD potentially due to its inclusion of creatinine
Journal of Hepatology"

A study in the most recent issue of the Journal of Hepatology assesses the revised MELD including estimated glomerular filtration rate.


The Model for End-Stage Liver Disease (MELD) allocation system for liver transplantation may present a disadvantage for women by including serum creatinine, which is typically lower in females.

Dr Robert Myers and colleagues from Canada investigated gender disparities in outcomes among liver transplantation candidates, and assessed a revised MELD, including estimated glomerular filtration rate (eGFR), for predicting waiting list mortality.

Adults registered for liver transplantation between 2002 and 2007 were identified using the UNOS database.


The researchers compared components of MELD, MDRD-derived eGFR, and the 3-month probability of liver transplantation and death between genders.

Discrimination of MELD, MELDNa, and revised models including eGFR for mortality were compared using c-statistics.

The research team reported that a total of 40,393 patients met the inclusion criteria, 9% died and 24% underwent liver transplantation within 3 months of listing.
Compared with men, women had lower median serum creatinine, and mean MELD, but within most MELD strata, had higher bilirubin and INR.

The researchers found that after adjusting for relevant covariates including creatinine and body weight, women were less likely than men to receive a liver transplantation and had greater 3-month mortality.

Dr Myers' team commented, "Revision of MELD and MELDNa to include eGFR did not improve discrimination for 3-month mortality."
"The team observed that women are disadvantaged under MELD potentially due to its inclusion of creatinine."

"However, since including eGFR in MELD does not improve mortality prediction, alternative refinements are necessary."

J Hepatol 2011: 54(3): 401-402
24 February 2011