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NDT Advance Access published online on November 5, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp556
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK

Carol Goulding1, Evangelous Cholongitas1, Devi Nair1, Andrew Kerry1, David Patch1, Murat Akyol2, Simon Walker2, Derek Manas3, David Mc Clure3, Liesl Smith3, Neville Jamieson4, Ingela Oberg4, David Cartwright4 and Andrew K. Burroughs1

1 The Liver Unit, The Royal Free Hospital, London, UK 2 The Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK 3 The Liver Unit, The Newcastle upon Tyne NHS Hospital Trust, Newcastle upon Tyne, UK 4 The Liver Unit, Addenbrookes Hospital, Cambridge, UK

Correspondence and offprint requests to: Andrew K Burroughs; E-mail: Andrew.burroughs{at}royalfree.nhs.uk



  Abstract

The Model for End-Stage Liver Disease (MELD) or similar scoring system is proposed in the UK for prioritization for liver transplantation. We evaluated the reproducibility of creatinine measurements and therefore MELD scores in four liver transplant units in the UK.

Methods. All transplant units were invited to participate; four agreed to do so, contributing 36 patients awaiting liver transplantation. Blood was collected from these 36 and divided into aliquots then sent to the four participating centres. Every centre measured creatinine and bilirubin for every patient. The results were analysed for the degree of agreement between centres for creatinine and MELD scores using the Bland–Altman method and Wilcoxon rank test.

Results. The mean creatinine value varied from 101 µmol/l in centre C to 110 µmol/l for the same sample in centre A, with significant differences between the four centres (P < 0.05, Wilcoxon signed-rank test). The MELD scores were significantly different between centre C and all other centres (P < 0.05).

Conclusion. This study demonstrates lack of agreement in measurement of serum creatinine and MELD scoring between four UK transplant centres. A difference in two MELD points can have a significant impact on patient outcome, and these factors will have to be addressed if a UK-wide transplant list is to be initiated.

Keywords: creatinine; liver transplant; MELD score; organ allocation

Received for publication: 12. 6.09
Revision received 29. 8.09. Accepted in revised form: 24. 9.09


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