Reducing liver transplant waiting-list mortality in Europe

Reducing liver transplant waiting-list mortality in Europe

A European study has demonstrated that prioritising patients for liver disease transplants using the Model for End-stage Liver Disease Sodium (MELD-Na) score could reduce the 90-day waiting list mortality rates.

Prioritising patients for liver transplantation using the MELD-Na score, instead of the more commonly used MELD score, could increase the chances of high-risk patients receiving a transplant and reduce the risk of dying while on the waiting list, according to the results of a large study using data from the Eurotransplant network.

Researchers from Leiden University Medical Center in the Netherlands evaluated more than 5,000 patients with chronic liver disease who had been allocated to the Eurotransplant liver waiting list using the MELD score, and found that more than one-quarter of those who died within three months of being listed might have received a transplant if the MELD-Na score had been used instead.


The currently used MELD score estimates mortality risk for patients with end-stage liver disease using laboratory variables and has been used to prioritise patients on liver transplant lists for almost 20 years. However, the MELD score does not accurately reflect the risk of death in patients with hyponatremia (low sodium levels), which is an important predictor of mortality in patients on liver transplant lists.

The MELD-Na score, which does include serum sodium in the risk calculation, was adopted in the United States in 2016 for liver transplant prioritisation, however, is not yet used routinely across Europe.

According to Dr Ben Goudsmit from Leiden University Medical Center, who presented the study results at this year’s Digital International Liver Congress, a large proportion (40%) of patients on the transplant waiting list had hyponatremia, and these patients had a three-fold increased risk of dying within 90 days of being listed.

“We also found that, if the MELD-Na score had been used to prioritise patients instead of the MELD score, 26.3% of those who died within 90 days would have had a significantly higher chance of receiving a liver transplant”, he said. “This equates to a 4.9% reduction in 90-day waiting-list mortality. We believe that MELD-Na-based allocation would help to prioritise patients on European liver transplant waiting lists and reduce the number of patients who die before they get the chance of receiving this life-saving treatment”.

Professor Emmanuel Tsochatzis of the Royal Free Hospital and University College London, UK, and an EASL Governing Board member, said: “The MELD score was a breakthrough in the field of liver transplantation, as it ensured equity in patients assessed and listed for a transplant. Over the years, it became apparent that the addition of Na to the original equation improved the classification of patients, and the MELD-Na was subsequently adopted in the US in 2016.

“This study is an important step in introducing MELD-Na in the European liver transplant programmes, as it demonstrated an almost 5% improvement in 90-day waiting list mortality.”

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