Impact of MELD 3.0 Score on Outcomes After Combined Heart–Liver Transplantation: A UNOS Database Analysis

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-10-11 DOI:10.1111/ctr.70713

Gabriel Esmailian, Sangrag Ganguli, Richard Jiang, Alejandro Alvarez Lobo, Oliver Jawitz, Divyam Goel, Chetan Patel, Adam DeVore, Stuart Russell, Matthew Kappus, Lindsay King, Stuart Knechtle, Debra Sudan, Jeffrey Keenan, Jacob Schroder, Carmelo Milano

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引用次数: 0

Abstract

Introduction

Combined heart-liver transplantation (CHLT) is performed for select patients with end-stage heart and liver disease, though the prognostic value of the Model for End-Stage Liver Disease (MELD) score in this population remains unclear.

Methods

We evaluated adult CHLT recipients between March 2005 and May 2025 from the United Network for Organ Sharing database. Groups were stratified by MELD 3.0 score at transplant: 1–14 (Low), 15–24 (Medium), ≥25 (High). Kaplan-Meier analyses assessed overall survival and freedom from liver graft failure, and Cox proportional hazards analysis evaluated risk factors for mortality after CHLT.

Results

Among 601 CHLT patients, there were 231 Low MELD, 314 Medium MELD, and 56 High MELD. Kaplan Meier analyses showed no difference in survival or liver graft failure between the groups (p = 0.22 and p = 0.22, respectively). One-year survival for the Low, Med, and High MELD groups was 82.6% [95% CI 77.8%–87.8%], 82.6% [95% CI 78.4%–87.0%], and 90.2% [95% CI 82.4%–98.8%], respectively. Five-year survival for the Low, Med, and High MELD groups was 73.8% [95% CI 67.6%–80.5%], 76.9% [95% CI 71.9%–82.1%], and 82.0% [95% CI 71.2%–94.5%], respectively. Cox proportional hazards analysis did not show MELD 3.0 score as a risk factor for mortality after CHLT (HR 0.98, 95% CI 0.94%–1.01; p = 0.144).

Conclusion

CHLT recipients have comparable long-term survival and liver graft failure rates regardless of MELD 3.0 score. For all three groups, mortality risk is greater during the first year. These findings suggest that MELD 3.0 may have limited prognostic utility in CHLT and support continued consideration of combined transplantation in appropriately selected patients despite elevated MELD 3.0 scores.

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MELD 3.0评分对心脏-肝联合移植后预后的影响：UNOS数据库分析。

虽然终末期肝病模型（MELD）评分在这一人群中的预后价值尚不清楚，但联合心肝移植（CHLT）是对患有终末期心脏病和肝脏疾病的患者进行的选择。方法：我们评估了2005年3月至2025年5月来自美国器官共享网络数据库的成人CHLT受者。按移植时MELD 3.0评分进行分组：1-14分（低）、15-24分（中）、≥25分（高）。Kaplan-Meier分析评估了总生存率和无肝移植衰竭，Cox比例风险分析评估了CHLT后死亡的危险因素。结果：601例CHLT患者中，低MELD 231例，中MELD 314例，高MELD 56例。Kaplan Meier分析显示两组患者的生存率和肝移植衰竭无差异（分别为p = 0.22和p = 0.22）。低、中、高MELD组的1年生存率分别为82.6% [95% CI 77.8%-87.8%]、82.6% [95% CI 78.4%-87.0%]和90.2% [95% CI 82.4%-98.8%]。低、中、高MELD组的5年生存率分别为73.8% [95% CI 67.6%-80.5%]、76.9% [95% CI 71.9%-82.1%]和82.0% [95% CI 71.2%-94.5%]。Cox比例风险分析未显示MELD 3.0评分是CHLT术后死亡率的危险因素（HR 0.98, 95% CI 0.94%-1.01; p = 0.144）。结论：无论MELD 3.0评分如何，CHLT受者的长期生存率和肝移植失败率相当。对于这三组人来说，第一年的死亡风险更高。这些研究结果表明，MELD 3.0在CHLT中可能具有有限的预后效用，尽管MELD 3.0评分升高，但仍支持在适当选择的患者中继续考虑联合移植。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.