Elsevier

Journal of Hepatology

Volume 54, Issue 6, June 2011, Pages 1297-1306
Journal of Hepatology

Frontiers in Liver Transplantation
The MELD score in patients awaiting liver transplant: Strengths and weaknesses

https://doi.org/10.1016/j.jhep.2010.11.008Get rights and content
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Adoption of the Model for End-stage Liver Disease (MELD) to select and prioritize patients for liver transplantation represented a turning point in organ allocation. Prioritization of transplant recipients switched from time accrued on the waiting list to the principle of “sickest first”.

The MELD score incorporates three simple laboratory parameters (serum creatinine and bilirubin, and INR for prothrombin time) and stratifies patients according to their disease severity in an objective and continuous ranking scale. Concordance statistics have demonstrated its high accuracy in stratifying patients according to their risk of dying in the short-term (three months). Further validations of MELD as a predictor of survival at various temporal end-points have been obtained in independent patient cohorts with a broad spectrum of chronic liver disease. The MELD-based liver graft allocation policy has led to a reduction in waitlist new registrations and mortality, shorter waiting times, and an increase in transplants, without altering overall graft and patient survival rates after transplantation.

MELD limitations are related either to the inter-laboratory variability of the parameters included in the score, or to the inability of the formula to predict mortality accurately in specific settings. For some conditions, such as hepatocellular carcinoma, widely accepted MELD corrections have been devised. For others, such as persistent ascites and hyponatremia, attempts to improve MELD’s predicting power are currently underway, but await definite validation.

Keywords

Liver transplantation
MELD score
End-stage liver disease
Organ allocation policy
Hepatocellular carcinoma
Complications of cirrhosis

Abbreviations

OLT
orthotopic liver transplantation
MELD
model for end-stage liver disease
UNOS
United Network for Organ Sharing
CTP
Child-Turcotte-Pugh
INR
international normalized ratio
HCC
hepatocellular carcinoma
GFR
glomerular filtration rate
MDRD
Modification of Diet in Renal Disease
MELD-Na
MELD and serum sodium
iMELD
integrated MELD
UKELD
United Kingdom MELD
MESO
MELD to serum sodium ratio
PT
prothrombin time

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