{"title":"MELD 3.0 PERFORMANCE: EXTERNAL VALIDATION IN A LATIN AMERICAN TRANSPLANT LIVER COHORT","authors":"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","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.
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.