Liver disease severity score predicts early and late mortality after lung transplantation: A United Network for Organ Sharing database analysis

Hepatorenal dysfunction after lung transplantation is associated with significant morbidity and mortality. The Model for End-stage Liver Disease excluding international normalized ratio (MELD-XI) score may predict outcomes after lung transplantation. Adult lung transplant recipients from the United Network for Organ Sharing database were identified (2010-2024) and stratified by MELD-XI score: low (≤9), intermediate (>9 to <13), and high (≥13) categories. Multivariate logistic regression and Cox proportional hazard models were applied to determine associations between MELD-XI score and postoperative outcomes. Among 30,148 lung transplant recipients, 90.6% had low, 6.9% intermediate, and 2.5% high MELD-XI scores at time of transplant listing. Greater MELD-XI score was associated with significantly increased mortality at 30-day, 90-day, 1-year, 5-year, and 10-year time points ( P < .001). On adjusted analysis, intermediate and high MELD-XI categories had greater mortality risk versus low (HR 1.16 and 1.41, respectively; P < .001). Patients with high MELD-XI also experienced more frequent severe complications, including postoperative dialysis (26.9% vs 6.7% in low MELD-XI), extracorporeal membrane oxygenation support (23.9% vs 7.8%), grade 3 primary graft dysfunction (43.9% vs 30.2%), and prolonged hospital stay >30 days (38.3% vs 23.8%) (all P < .001). Preoperative MELD-XI scores >9 independently predicted greater posttransplant mortality and major complications. Incorporating MELD-XI into lung transplant candidate assessments can improve risk stratification and inform perioperative planning.