Predicting Survival in Combined Heart-Liver Transplantation Compared to Heart Transplantation Alone

Purpose As the number of heart-liver transplants increases, an understanding of the benefits and risks becomes increasingly important for appropriate multiorgan allocation. The model for end-stage liver disease and serum sodium level (MELD-Na) score is used as a predictor of survival in patient with liver disease. It is used to prioritize liver transplant recipients on the waitlist. We expected that patients with higher MELD-Na scores who underwent heart-liver transplant would have a higher postoperative survival than those patients with high MELD-Na scores who underwent heart transplant alone. The goal of our study was to determine if MELD-Na is a useful metric for allocating heart-liver transplants. Methods We retrospectively analyzed both heart-liver transplant recipients enrolled in the United Network for Organ Sharing database and all heart transplant recipients from the Stanford University with complete data for the covariates used in our model. Recipient MELD-Na scores were calculated for transplant recipients in both groups. The risk of death was assessed using a multivariable Cox proportional hazard model with adjustment for age of donor, age of recipient, recipient diabetes, and recipient intra-aortic balloon pump at time of transplant. We investigated whether MELD-Na predicted survival in heart-liver recipients. Results A total of 326 patients enrolled in UNOS underwent heart-liver transplantation and a total of 278 patients underwent heart transplantation at Stanford. The interaction effect of the type of transplant received (heart-liver vs heart alone) and MELD-Na was not significant for survival at 30 days (p = 0.812), 1 year (p = 0.859), 3 years (p = 0.621), and 5 years (p = 0.448). Furthermore, in the heart-liver cohort, MELD-Na did not significantly predict survival at 30 day (p = 0.461), 1 year (p = 0.153), 3 years (p = 0.169), and 5 years (0.169). Conclusion We found that patients with higher MELD-Na scores who underwent heart-liver transplantation did not have a higher postoperative survival when compared to those patients with high MELD-Na who underwent heart transplant alone. Therefore, MELD-Na is not a useful metric for allocating heart-liver transplants. As the number of heart-liver transplants increases, an understanding of the benefits and risks becomes increasingly important for appropriate multiorgan allocation. The model for end-stage liver disease and serum sodium level (MELD-Na) score is used as a predictor of survival in patient with liver disease. It is used to prioritize liver transplant recipients on the waitlist. We expected that patients with higher MELD-Na scores who underwent heart-liver transplant would have a higher postoperative survival than those patients with high MELD-Na scores who underwent heart transplant alone. The goal of our study was to determine if MELD-Na is a useful metric for allocating heart-liver transplants. We retrospectively analyzed both heart-liver transplant recipients enrolled in the United Network for Organ Sharing database and all heart transplant recipients from the Stanford University with complete data for the covariates used in our model. Recipient MELD-Na scores were calculated for transplant recipients in both groups. The risk of death was assessed using a multivariable Cox proportional hazard model with adjustment for age of donor, age of recipient, recipient diabetes, and recipient intra-aortic balloon pump at time of transplant. We investigated whether MELD-Na predicted survival in heart-liver recipients. A total of 326 patients enrolled in UNOS underwent heart-liver transplantation and a total of 278 patients underwent heart transplantation at Stanford. The interaction effect of the type of transplant received (heart-liver vs heart alone) and MELD-Na was not significant for survival at 30 days (p = 0.812), 1 year (p = 0.859), 3 years (p = 0.621), and 5 years (p = 0.448). Furthermore, in the heart-liver cohort, MELD-Na did not significantly predict survival at 30 day (p = 0.461), 1 year (p = 0.153), 3 years (p = 0.169), and 5 years (0.169). We found that patients with higher MELD-Na scores who underwent heart-liver transplantation did not have a higher postoperative survival when compared to those patients with high MELD-Na who underwent heart transplant alone. Therefore, MELD-Na is not a useful metric for allocating heart-liver transplants.