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Impact of Inter-Laboratory Variability on Model of End-Stage Liver Disease (MELD) Score Calculation

Mohammed Al-Saeedi, Taha Yassein, Daniel Schultze, Arash Nickkholgh, Helge Bruns, Markus Zorn, Ulf Hinz, Tom M. Ganten, Peter Schemmer

(Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany)

Ann Transplant 2016; 21:675-682

DOI: 10.12659/AOT.899241

BACKGROUND: The model for end-stage liver disease (MELD) is a laboratory-based scoring system for assessing the severity of liver disease. Since 16 December 2006, MELD-based organ allocation for liver transplantation (LT) has been established in Germany to prioritize the sickest patients. The present study was designed to evaluate the effect of using different laboratories on the calculated MELD score, despite the use of mandatory round-robin testing for comparable of inter-laboratory results.
MATERIAL AND METHODS: Blood samples were taken from 10 patients with liver disease. Bilirubin, creatinine, and INR were measured in 6 different laboratories. The patients’ MELD scores were calculated and the inter-laboratory variability was compared.
RESULTS: The highest discrepancy between the laboratories was 5 MELD score points and the highest inter-laboratory difference for bilirubin, INR, and creatinine was 4.6, 1.2, and 0.99 mg/dl, respectively. Pairwise comparison of the laboratory values showed a significant inter-laboratory difference (p<0.05).
CONCLUSIONS: Results clearly demonstrate, for the first time, that liver allocation for LT in Germany is based on nationwide noncomparable laboratory readouts for the MELD score.

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