A consensus has been reached that liver donor allocation should be based primarily on liver disease severity and that waiting time should not be a major determining factor. Our aim was to assess the capability of the Model for End-Stage Liver Disease (MELD) score to correctly rank potential liver recipients according to their severity of liver disease and mortality risk on the OPTN liver waiting list.
The MELD model predicts liver disease severity based on serum creatinine, serum total bilirubin, and INR and has been shown to be useful in predicting mortality in patients with compensated and decompensated cirrhosis. In this study, we prospectively applied the MELD score to estimate 3-month mortality to 3437 adult liver transplant candidates with chronic liver disease who were added to the OPTN waiting list at 2A or 2B status between November, 1999, and December, 2001.
In this study cohort with chronic liver disease, 412 (12%) died during the 3-month follow-up period. Waiting list mortality increased directly in proportion to the listing MELD score. Patients having a MELD score <9 experienced a 1.9% mortality, whereas patients having a MELD score > or =40 had a mortality rate of 71.3%. Using the c-statistic with 3-month mortality as the end point, the area under the receiver operating characteristic (ROC) curve for the MELD score was 0.83 compared with 0.76 for the Child-Turcotte-Pugh (CTP) score (P < 0.001).
These data suggest that the MELD score is able to accurately predict 3-month mortality among patients with chronic liver disease on the liver waiting list and can be applied for allocation of donor livers.
"Then, the Child-Pugh and the Model for End-Stage Liver Disease (MELD) scores  were calculated for each patient and study subjects were classified according to Child-Pugh class and MELD category . "
"Lower hemoglobin levels indicate inadequate reserve to compensate for blood loss, and this risk has been identified with various cutoff values in previous studies [30,36–42]. Second, cMELD score was a prospectively validated predictor for survival in patients with endstage liver diseases awaiting OLT . Higher cMELD scores may indicate worse residual liver functions, and could be associated with susceptibility to coagulopathy. "
"In the majority of U.S.A. and European LT centres, patients with a T2-HCC receive an arbitrary MELD score initially set at 22 points independently of their liver function    . This means that the current system gives the same priority to a T2-HCC patient with a very low MELD score (<10) and a non-HCC patient with a biochemical MELD score of 22, but at the same time gives the same priority to a patients with MELD >22 and HCC with respect to a non-HCC patient with the same MELD. "
Nwe Ni Than, Christiane Wiegard, Christina Weiler-Normann, Katja Füssel, Jake Mann, James Hodson, Gideon M Hirschfield, Ansgar W Lohse, David H Adams, Christoph Schramm, Ye Htun Oo
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