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Model for end-stage liver disease score and MELD exceptions: 15 years later

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Abstract

The model for end-stage liver disease (MELD) score has been used as an objective scale of disease severity for management of patients with end-stage liver disease; it currently serves as the basis of an urgency-based organ-allocation policy in several countries. Implementation of the MELD score led to a reduction in waiting-list registration and waiting-list mortality and an increase in the number of deceased-donor transplants without adversely affecting long-term outcomes after liver transplantation (LT). The MELD score has been used for management of non-transplant patients with chronic liver disease. MELD exceptions serve as a mechanism to advance the needs of subsets of patients with liver disease not adequately addressed by MELD-based organ allocation. Several models have been proposed to refine and improve the MELD score as the environment within which it operates continues to evolve toward transplantation for sicker patients. The MELD score continues to serve and be used as a template to improve upon as an objective gauge of disease severity and as a metric enabling optimization of allocation of scarce donor organs for LT.

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Abbreviations

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

INR:

International normalized ratio

HCC:

Hepatocellular carcinoma

HCV:

Chronic viral hepatitis C

TIPS:

Transjugular intrahepatic portosystemic shunt

c statistic:

Concordance statistic

CTP:

Child–Turcotte–Pugh

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Compliance with ethical requirements and Conflict of interest

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all the patients included in this study. Sumeet Asrani and Patrick Kamath declare that they have no conflict of interest.

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  1. Baylor University Medical Center, 3410 Worth Street Suite 860, Dallas, TX, 75246, USA

    Sumeet K. Asrani

  2. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Patrick S. Kamath

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  1. Sumeet K. Asrani
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Correspondence to Sumeet K. Asrani.

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Asrani, S.K., Kamath, P.S. Model for end-stage liver disease score and MELD exceptions: 15 years later. Hepatol Int 9, 346–354 (2015). https://doi.org/10.1007/s12072-015-9631-3

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