MELD-Na Alterations on the Liver Transplant Waiting List and Their Impact on Listing Outcome

Background: Dynamic MELD deterioration (Delta MELD) during waiting time was shown to have significant impact on post-transplant survival. The aim of this study was to analyze the impact of MELD-Na score alterations on waiting list outcomes in liver transplant candidates. Method: 36,806 patients listed at UNOS for liver transplantation in 2011-2015 were analyzed according to their delisting reasons. Several different MELD-Na alterations during waiting time were analyzed (e.g., maximal change, last change before delisting/transplantation). Outcome estimates were calculated according to MELD-Na scores at listing and Delta MELD. Results: Patients who died while on the waiting list showed a significantly higher deterioration in MELD-Na during the waiting time (6.8 +/- 8.4 points) than stable patients who remained actively listed (-0.1 +/- 5.2 points; p < 0.01). Patients who were considered too healthy for transplantation improved by more than 3 points on average during the waiting time. The mean peak MELD-Na alteration during the waiting time was 10.0 +/- 7.6 for patients who died on the waiting list, compared to 6.6 +/- 6.1 in the group of patients who finally underwent transplantation. Conclusions: Deterioration of MELD-Na during waiting time and maximal MELD-Na deterioration have a significant negative impact on the liver transplant waiting list outcome.