A model including standardized weight improved predicting waiting list mortality in adolescent liver transplant candidates: A US national study

Abstract

The Model for End-Stage Liver Disease (MELD) score has been employed to identify adolescents eligible for liver transplantation since 2004. However, the optimal model for prioritizing adolescent candidates is uncertain. In our study, we aimed at evaluating the value of adding anthropometric variables to liver transplantation allocation models among adolescents. We conducted a retrospective cohort study using the data from the Organ Procurement and Transplantation Network Standard Transplant Analysis and Research to identify adolescent patients registered on the liver transplant waiting list in the United States between January 1, 2003, and December 31, 2022. Adolescents (12–17 y) who were listed for their first liver transplantation were included. We evaluated the performance of different models including pediatric end-stage liver disease with Na and creatinine, MELD, and MELD 3.0. Furthermore, we evaluated whether adding anthropometric variables (z-score for weight and height) would improve the models’ performance for our primary outcome (mortality at 90 days after listing). We identified 1421 eligible adolescent patients. Adding a z-score of weight (MELD-TEEN) improved the performance and discrimination of the MELD score. The final model including weight z-score (MELD-TEEN) had better discriminative power compared to MELD 3.0 and pediatric end-stage liver disease with Na and creatinine in the overall cohort and in different age groups (ages 12–14 and 15–17). MELD-TEEN could improve the accuracy of allocation of liver transplants among adolescents by incorporating the weight z-score compared to MELD 3.0 and pediatric end-stage liver disease with Na and creatinine.