The Model for End-Stage Liver Disease (MELD) and allocation of donor livers

Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Gastroenterology (Impact Factor: 16.72). 01/2003; 124(1):91-6. DOI: 10.1053/gast.2003.50016
Source: PubMed


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.

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    • "Then, the Child-Pugh and the Model for End-Stage Liver Disease (MELD) scores [16] were calculated for each patient and study subjects were classified according to Child-Pugh class and MELD category [17]. "
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    ABSTRACT: This study evaluated the contribution of β-cell dysfunction and insulin resistance to cirrhosis-associated diabetes. One-hundred and sixty cirrhotic patients with normal fasting plasma glucose (FPG), three with impaired fasting glucose and seven with untreated diabetes mellitus (DM) underwent an extended oral glucose tolerance test (OGTT). The OGTT data were analyzed with a Minimal Model to estimate dynamic (derivative) control (DC) and static (proportional) control (PC) of β-cell function, and with the Oral Glucose Insulin Sensitivity (OGIS)-2h index to estimate insulin sensitivity. Twenty-six patients (15.6%) had normal glucose tolerance (NGT), 60 (35.8%) had impaired glucose tolerance (IGT), and 84 (48.6%) had DM. DC was significantly reduced in DM vs. NGT and IGT patients. PC was significantly impaired in DM and IGT vs. NGT patients and in DM vs. IGT subjects. The OGIS-2h index was significantly reduced to a similar extent in DM and IGT vs. NGT patients. Patients with Child-Pugh class B and C cirrhosis had reduced DC and PC, but not OGIS-2h values, as compared with subjects in class A. Moreover, Child-Pugh class/score was an independent predictor of β-cell function even after adjustment for glucose tolerance. Abnormalities of glucose tolerance occur frequently in cirrhosis, even in patients with normal FPG, thereby supporting the importance of performing an OGTT. Transition from IGT to DM is driven primarily by β -cell dysfunction. Insulin secretion worsens in parallel with the severity of liver disease, thus suggesting a detrimental effect of liver failure on pancreatic islets on its own. Copyright © 2015. Published by Elsevier B.V.
    Journal of Hepatology 08/2015; DOI:10.1016/j.jhep.2015.08.011 · 11.34 Impact Factor
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    • "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 [43]. Higher cMELD scores may indicate worse residual liver functions, and could be associated with susceptibility to coagulopathy. "
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    ABSTRACT: To identify preoperative predictors for the use of any blood component during and after orthotopic liver transplantation (OLT), we performed a retrospective analysis on 602 OLT patients who were randomly split into a training set (n = 482) and a validation set (n = 120). Hemoglobin and calculated MELD score were identified as independent predictors for blood use using bootstrap aggregation. A logistic regression model constructed using both variables showed comparable performance in the training and validation sets. Predictive scores can be obtained from a nomogram, and a score above -2.328 predicted transfusion of any blood component with a positive predictive value of 97% and 96% in the training and validation sets, respectively. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Transfusion and Apheresis Science 08/2015; DOI:10.1016/j.transci.2015.07.008 · 0.77 Impact Factor
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    • "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 [4] [5] [6] [7]. 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. "

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