Higher model for end-stage liver disease excluding international normalized ratio scores predict worse kidney graft outcomes in simultaneous heart-kidney transplantation.

BACKGROUND: While the model for end-stage liver disease excluding international normalized ratio (MELD-XI) is known to be associated with adverse outcomes following cardiac surgery and heart transplantation, its predictive value in outcomes of simultaneous heart-kidney transplant (SHKT) remains unclear. To identify a reliable pre-transplant risk marker for graft and patient survival among SHKT recipients, we hypothesized that higher MELD-XI scores are linked to worse post-transplant outcomes. AIM: To determine the association between MELD-XI and post-transplant outcomes in SHKT recipients. METHODS: We performed a retrospective cohort study in adult SHKT recipients using the United Network for Organ Sharing database from 2014 to 2023. MELD-XI was calculated and categorized into tertiles (high, medium and low). Multivariable Cox proportional hazards models and generalized additive models were used to evaluate the association between MELD-XI and patient mortality and kidney graft failure. RESULTS: Among the cohort of 2148 SHKT recipients the MELD-XI tertile distribution was: High (11%), medium (56%), and low (36%). Statistically significant differences among recipients in the highest tertile were seen and they were younger, more frequently female, had higher rates of dialysis, and shorter waitlist times. Recipients in the higher MELD-XI tertile also had significant increase in the delayed kidney graft function and longer hospital stays after transplantation. On multivariable analysis, MELD-XI independently predicted increase in 90-day graft failure, and 1-year graft failure and mortality. CONCLUSION: Higher MELD-XI is associated with increased early mortality and kidney graft failure in SHKT recipients. MELD-XI can provide an objective risk-stratification tool to help identify candidates who should undergo SHKT vs kidney-after-heart transplantation.