MELD 3.0 PERFORMANCE: EXTERNAL VALIDATION IN A LATIN AMERICAN TRANSPLANT LIVER COHORT

IF 4.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Josefina Pages Maronese , Federico Piñero , Graciela Castro Narro , Yahvé Iván López Méndez , Ignacio Roca , Nicolas Dominguez , Fernando Cairo , Angelo Z. Mattos , Natalia Baumgartner Ayres , Bertha Eliana Cárdenas Ramírez , Estefania Liza Baca , Julio Benitez Perez , Alejandra Villamil , Alexandra Ginesta , Rodrigo Zapata , Gustavo Pereira , Florencia Antinucci , Aldo Torre Delgadillo , Marcelo Silva , Manuel Mendizabal
{"title":"MELD 3.0 PERFORMANCE: EXTERNAL VALIDATION IN A LATIN AMERICAN TRANSPLANT LIVER COHORT","authors":"Josefina Pages Maronese ,&nbsp;Federico Piñero ,&nbsp;Graciela Castro Narro ,&nbsp;Yahvé Iván López Méndez ,&nbsp;Ignacio Roca ,&nbsp;Nicolas Dominguez ,&nbsp;Fernando Cairo ,&nbsp;Angelo Z. Mattos ,&nbsp;Natalia Baumgartner Ayres ,&nbsp;Bertha Eliana Cárdenas Ramírez ,&nbsp;Estefania Liza Baca ,&nbsp;Julio Benitez Perez ,&nbsp;Alejandra Villamil ,&nbsp;Alexandra Ginesta ,&nbsp;Rodrigo Zapata ,&nbsp;Gustavo Pereira ,&nbsp;Florencia Antinucci ,&nbsp;Aldo Torre Delgadillo ,&nbsp;Marcelo Silva ,&nbsp;Manuel Mendizabal","doi":"10.1016/j.aohep.2025.101954","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The MELD 3.0 score has demonstrated superior discriminatory performance for predicting 90-day waitlist mortality among liver transplant (LT) candidates in the US. This study aimed to validate the MELD 3.0 in a Latin American cohort.</div></div><div><h3>Materials and Methods</h3><div>Retrospective cohort study including adults LT candidates listed between 2016-2023 across five Latin American countries. Baseline data were registered at listing. Cox regression model was performed, with 90-day mortality as the primary outcome and LT as censored observation. Discriminative performance was assessed using Harrell´s c-index for MELD, MELD-Na and MELD 3.0. Net Reclassification Index (NRI) was also calculated.</div></div><div><h3>Results</h3><div>We included 1,013 patients: mean age 51 years (±11.8); 41.4% females, 25.8% obese, 58.1% ascites and 38.3% had encephalopathy were present in 58.1% and 38.3% of cases, respectively. Median MELD score was 16.9 (IQR 13.3–21.1), MELD-Na 18.3 (IQR 14.6–24), and MELD 3.0 19.5 (IQR 15.1–24.8). At 90 days, 26.3% underwent LT and 66.8% remained on the waitlist. The mortality incidence was 29.4 deaths per 1,000 patient-months, with a cumulative mortality of 8.3% (95% CI 6.6–10.4%) at 3 months. Hazard ratios for 90-day mortality were: MELD 1.15 (95% CI 1.12-1.19), MELD-Na 1.16 (95% CI 1.13-1.20), and MELD 3.0 1.15 (95% CI 1.12-1.19). Harrell’s c-index showed no significant differences (Table 1).NRI showed no significant improvement in risk reclassification using MELD 3.0.</div></div><div><h3>Conclusions</h3><div>In a region showing high waitlist mortality, MELD 3.0 did not demonstrate superior predictive performance over MELD or MELD-Na. These findings highlight the need for regional validation of predictive models before implementation in transplant priorization policies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101954"},"PeriodicalIF":4.4000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of hepatology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1665268125001796","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction and Objectives

The MELD 3.0 score has demonstrated superior discriminatory performance for predicting 90-day waitlist mortality among liver transplant (LT) candidates in the US. This study aimed to validate the MELD 3.0 in a Latin American cohort.

Materials and Methods

Retrospective cohort study including adults LT candidates listed between 2016-2023 across five Latin American countries. Baseline data were registered at listing. Cox regression model was performed, with 90-day mortality as the primary outcome and LT as censored observation. Discriminative performance was assessed using Harrell´s c-index for MELD, MELD-Na and MELD 3.0. Net Reclassification Index (NRI) was also calculated.

Results

We included 1,013 patients: mean age 51 years (±11.8); 41.4% females, 25.8% obese, 58.1% ascites and 38.3% had encephalopathy were present in 58.1% and 38.3% of cases, respectively. Median MELD score was 16.9 (IQR 13.3–21.1), MELD-Na 18.3 (IQR 14.6–24), and MELD 3.0 19.5 (IQR 15.1–24.8). At 90 days, 26.3% underwent LT and 66.8% remained on the waitlist. The mortality incidence was 29.4 deaths per 1,000 patient-months, with a cumulative mortality of 8.3% (95% CI 6.6–10.4%) at 3 months. Hazard ratios for 90-day mortality were: MELD 1.15 (95% CI 1.12-1.19), MELD-Na 1.16 (95% CI 1.13-1.20), and MELD 3.0 1.15 (95% CI 1.12-1.19). Harrell’s c-index showed no significant differences (Table 1).NRI showed no significant improvement in risk reclassification using MELD 3.0.

Conclusions

In a region showing high waitlist mortality, MELD 3.0 did not demonstrate superior predictive performance over MELD or MELD-Na. These findings highlight the need for regional validation of predictive models before implementation in transplant priorization policies.
Meld 3.0性能:拉丁美洲移植肝脏队列的外部验证
在美国,MELD 3.0评分在预测肝移植(LT)候选人90天等待名单死亡率方面表现出优越的歧视性表现。本研究旨在验证拉丁美洲队列中的MELD 3.0。材料和方法回顾性队列研究,包括来自五个拉丁美洲国家的2016-2023年成人LT候选人。入组时登记基线数据。采用Cox回归模型,以90天死亡率为主要转归,LT为截尾观察。采用Harrell’s c-index对MELD、MELD- na和MELD 3.0的判别性能进行评价。计算净重分类指数(NRI)。结果纳入1013例患者:平均年龄51岁(±11.8);女性占41.4%,肥胖占25.8%,腹水占58.1%,脑病占38.3%。中位MELD评分为16.9 (IQR为13.3-21.1),MELD- na评分为18.3 (IQR为14.6-24),MELD 3.0评分为19.5 (IQR为15.1-24.8)。在90天,26.3%的患者接受了肝移植,66.8%的患者仍在等待名单上。死亡率为每1000个患者月29.4例死亡,3个月时的累积死亡率为8.3% (95% CI 6.6-10.4%)。90天死亡率的风险比为:MELD 1.15 (95% CI 1.12-1.19), MELD- na 1.16 (95% CI 1.13-1.20), MELD 3.0 1.15 (95% CI 1.12-1.19)。Harrell’s c指数差异无统计学意义(表1)。使用MELD 3.0进行风险再分类时,NRI没有明显改善。结论在等待名单死亡率高的地区,MELD 3.0的预测性能并不优于MELD或MELD- na。这些发现强调了在移植优先政策实施之前需要对预测模型进行区域验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Annals of hepatology
Annals of hepatology 医学-胃肠肝病学
CiteScore
7.90
自引率
2.60%
发文量
183
审稿时长
4-8 weeks
期刊介绍: Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信