Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score predicts heart transplant outcomes: Evidence from the registry of the United Network for Organ Sharing

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 2; pp. 222 - 227
• Main Authors: Deo, Salil V., MS, MCh, Al-Kindi, Sadeer G., MD, Altarabsheh, Salah E., MD, Hang, Dustin, Kumar, Sachin, MD, Ginwalla, Mahazarin B., MD, ElAmm, Chantal A., MD, Sareyyupoglu, Basar, MD, Medalion, Benjamin, MD, Oliveira, Guilherme H., MD, Park, Soon J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2016
• Subjects: Adult; congestive heart failure; Female; Forecasting; heart transplant; Heart Transplantation - mortality; hepatic dysfunction; hepato-renal failure; Hepatorenal Syndrome; Humans; International Normalized Ratio; left ventricular assist device; Liver Diseases - physiopathology; Logistic Models; Male; MELD-XI; Middle Aged; Models, Biological; Proportional Hazards Models; Registries; Surgery; Treatment Outcome; congestive heart failure; heart transplant; MELD-XI; left ventricular assist device; hepato-renal failure; hepatic dysfunction
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2015.10.008

Background Hepato-renal function is a valuable predictor of success after left ventricular assist device therapy and heart transplantation. Hence, we analyzed the importance of the Model for End-stage Liver Disease excluding international normalized ratio (MELD-XI) score to outcomes after heart transplant. Methods Adults undergoing heart transplant from the United Network for Organ Sharing (UNOS) database were identified (1994 to 2014). Individual MELD-XI scores were calculated; patients were stratified by MELD-XI quartiles (Q1 to Q4). Multivariate logistic regression and the Cox proportional hazard model were implemented to determine any association between MELD-XI scores, survival and other outcomes. Results From 39,711 patients undergoing OHT during the study period, MELD-XI score [median 10.7 (interquartile range 7.0 to 14.4)] was calculated for 36,005 patients (76% male and 75% white, 34% Status 1A). Higher MELD-XI scores had higher rates of pre-transplant extracorporeal membrane oxygenation, intra-aortic balloon pump, inotrope use and mechanical ventilation ( p < 0.001 for all). Adjusted long-term mortality (median follow-up 8.1 years) was associated with MELD-XI score (hazard ratio [HR] 1.021 [1.016 to 1.026], p < 0.001). The highest MELD-XI quartile was associated with an HR 1.364 [1.255 to 1.482] risk of mortality compared with Q1. MELD-XI score was also associated with increased post-transplant infections (adjusted HR Q4 vs Q1: 1.364 [1.153 to 1.614], p < 0.001), stroke (adjusted HR Q4 vs Q1: 1.410 [1.074 to 1.852], p = 0.013), dialysis (adjusted HR Q4 vs Q1: 3.982 [3.386 to 4.683], p < 0.001), rejection (adjusted HR Q4 vs Q1: 1.519 [1.286 to 1.795], p = 0.003) and prolonged hospitalization (adjusted HR Q4 vs Q1: 1.635 [1.429 to 1.871], p < 0.001). Conclusion Hepato-renal dysfunction, measured with MELD-XI score, predicts morbidity and mortality in patients undergoing orthotopic heart transplantation. Etiology of hepato-renal dysfunction should be sought and treated before heart transplantation.