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

Background and Aims: The model of end-stage liver disease (MELD) score has been employed to identify liver transplantation in adolescents since 2004. However, the optimal model or 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. Methods: We conducted a retrospective cohort study using data from the OPTN Standard Transplant Analysis and Research (STAR) to identify adolescent patients registered on the liver transplant waiting list in the United States between January 1, 2003 and December 31^st 2022. Adolescents (12-17 years) 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 (PELD-Na-Cr), 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 post-listing). Results: We identified 1421 eligible adolescent patients. Adding z-score of weight (MELD-TEEN) improved the performance and discrimination of MELD score. The final model including weight z-score (MELD-TEEN) had better discriminative power compared to MELD 3.0 and PELD-Na-Cr in the overall cohort and in different age groups (age 12-14 and 15-17). Conclusion: MELD-TEEN could improve the accuracy of allocation of liver transplant among adolescents by incorporating weight z-score compared to MELD 3.0 and PELD-Na-Cr.