In addition, the demographics of liver disease patients have changed since 2002, reducing the overall accuracy of MELD scoring, according to Allison Kwong, MD, an instructor in gastroenterology and hepatology as well as a co-author of the MELD 3.0 paper. When the model was created, nearly a third of patients on the waitlist had hepatitis C. Patients on the waitlist today are more likely to be older, have alcoholic liver disease or fatty liver disease, and have comorbidities like diabetes and obesity — differences that make their mortality less predictable by the original model.
Last year, Kim, Kwong and their colleagues published a proposal for MELD 3.0 to address these issues.
Using three years of data from candidates who were on the liver transplant waitlist from 2016 through 2018, the researchers fine-tuned the model, adding 1.3 points for female candidates, including albumin (a measure of liver function and malnutrition) as a fifth blood test value, limiting the maximum level of creatinine, and adjusting for interactions among the variables.
Together, these alterations will not only level the playing field for women, but improve accuracy for all patients, Kim said.