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MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation.

Publication ,  Journal Article
Grimm, JC; Shah, AS; Magruder, JT; Kilic, A; Valero, V; Dungan, SP; Tedford, RJ; Russell, SD; Whitman, GJR; Sciortino, CM
Published in: Ann Thorac Surg
November 2015

BACKGROUND: The aim of this study was to determine the utility of the Model for End-Stage Liver Disease Excluding INR (MELD-XI) in predicting early outcomes (30 days and 1 year) and late outcomes (5 years) in patients after orthotopic heart transplantation (OHT). METHODS: The United Network for Organ Sharing database was queried for all adult patients (aged ≥ 18 years) undergoing OHT from 2000 to 2012. A MELD-XI was calculated and the population stratified into score quartiles. Early and late survivals were compared among the MELD-XI cohorts. Multivariable Cox proportional hazards models were constructed to determine the capacity of MELD-XI (when modeled both as a categoric and a continuous variable) to predict 30-day, 1-year, and 5-year mortality. Conditional models were also designed to determine the effect of early mortality on long-term survival. RESULTS: A total of 22,597 patients were included for analysis. The MELD-XI cutoff scores were established as follows: low (≤ 10.5), low-intermediate (10.6 to 12.6), intermediate-high (12.7 to 16.4), and high (>16.4). The high MELD-XI cohort experienced statistically worse 30-day, 1-year, and 5-year unconditional survivals when compared with patients with low scores (p < 0.001). Similarly, a high MELD-XI score was also predictive of early and late mortality (p < 0.001) after risk adjustment. There was, however, no difference in 5-year survival between the high score and low score cohorts after accounting for 1-year deaths. Subanalysis of patients bridged to transplant with a continuous-flow left ventricular assist device demonstrated similar findings. CONCLUSIONS: This is the first known study to examine the relationship between a high MELD-XI score and outcomes in patients after OHT. Patients with hepatic or renal dysfunction before OHT should be closely monitored and aggressively optimized as early mortality appears to drive long-term outcomes.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

November 2015

Volume

100

Issue

5

Start / End Page

1737 / 1743

Location

Netherlands

Related Subject Headings

  • Time Factors
  • Risk Assessment
  • Respiratory System
  • Prognosis
  • Models, Statistical
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans
  • Heart Transplantation
 

Citation

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Grimm, J. C., Shah, A. S., Magruder, J. T., Kilic, A., Valero, V., Dungan, S. P., … Sciortino, C. M. (2015). MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation. Ann Thorac Surg, 100(5), 1737–1743. https://doi.org/10.1016/j.athoracsur.2015.07.026
Grimm, Joshua C., Ashish S. Shah, J Trent Magruder, Arman Kilic, Vicente Valero, Samuel P. Dungan, Ryan J. Tedford, Stuart D. Russell, Glenn J. R. Whitman, and Christopher M. Sciortino. “MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation.Ann Thorac Surg 100, no. 5 (November 2015): 1737–43. https://doi.org/10.1016/j.athoracsur.2015.07.026.
Grimm JC, Shah AS, Magruder JT, Kilic A, Valero V, Dungan SP, et al. MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation. Ann Thorac Surg. 2015 Nov;100(5):1737–43.
Grimm, Joshua C., et al. “MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation.Ann Thorac Surg, vol. 100, no. 5, Nov. 2015, pp. 1737–43. Pubmed, doi:10.1016/j.athoracsur.2015.07.026.
Grimm JC, Shah AS, Magruder JT, Kilic A, Valero V, Dungan SP, Tedford RJ, Russell SD, Whitman GJR, Sciortino CM. MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation. Ann Thorac Surg. 2015 Nov;100(5):1737–1743.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

November 2015

Volume

100

Issue

5

Start / End Page

1737 / 1743

Location

Netherlands

Related Subject Headings

  • Time Factors
  • Risk Assessment
  • Respiratory System
  • Prognosis
  • Models, Statistical
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans
  • Heart Transplantation