Clinical applications of the Model for End-Stage Liver Disease (MELD) in hepatic medicine

Tsang Lau; Ahmad, Jawad
February 2013
Hepatic Medicine: Evidence & Research;2013, Vol. 5, p1
Academic Journal
The Model for End-Stage Liver Disease (MELD) score incorporates serum bilirubin, creatinine, and the international normalized ratio (INR) into a formula that provides a continuous variable that is a very accurate predictor of 90-day mortality in patients with cirrhosis. It is currently utilized in the United States to prioritize deceased donor organ allocation for patients listed for liver transplantation. The MELD score is superior to other prognostic models in patients with end-stage liver disease, such as the Child-Turcotte-Pugh score, since it uses only objective criteria, and its implementation in 2002 led to a sharp reduction in the number of people waiting for liver transplant and reduced mortality on the waiting list without affecting posttransplant survival. Although mainly adopted for use in patients waiting for liver transplant, the MELD score has also proved to be an effective predictor of outcome in other situations, such as patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis. Several variations of the original MELD score, involving the addition of serum sodium or looking at the change in MELD over time, have been examined, and these may slightly improve its accuracy. The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation. The application of the MELD score in prioritizing patients for liver transplantation has been successful, but further studies and legislation are required to ensure a fair and equitable system.


Related Articles

  • Differences in Access to Liver Transplantation: Disease Severity, Waiting Time, and Transplantation Center Volume. Ahmad, Jawad; Bryce, Cindy L.; Cacciarelli, Thomas; Roberts2, Mark S. // Annals of Internal Medicine;5/15/2007, Vol. 146 Issue 10, p707 

    Background: The Model for End-Stage Liver Disease (MELD) score has been used since February 2002 to allocate livers for transplantation from deceased donors according to medical need. Allocation based on MELD scores should ensure that sicker patients receive transplants first regardless of...

  • IMPORTANT BILIARY DRAINAGE VARIATIONS OF LEFT LIVER LOBE. Jurkovikj, D. // Contributions of Macedonian Academy of Sciences & Arts;2009, Vol. 30 Issue 2, p81 

    Biliary drainage of the left liver lobe has been examined in view of the current surgical trends for using the left liver lobe of living parent donor for liver transplantation. For this purpose, on 13 acrylic casts of porto-biliary elements of the liver, variations of pattern and level of...

  • Recent Advances in Decellularization and Recellularization for Tissue-Engineered Liver Grafts. Wang, Yujia; Nicolas, Clara T.; Chen, Harvey S.; Ross, Jeffery J.; De Lorenzo, Silvana B.; Nyberg, Scott L. // Cells Tissues Organs;Apr2017, Vol. 203 Issue 4, p203 

    Liver transplantation from deceased or living human donors remains the only proven option for patients with end-stage liver disease. However, the shortage of donor organs is a significant clinical concern that has led to the pursuit of tissue-engineered liver grafts generated from decellularized...

  • Determinants of Liver Damage Associated with Intravenous Methylprednisolone Pulse Therapy in Graves' Ophthalmopathy. Rosario Le Moli; Lelio Baldeschi; Peerooz Saeed; Noortje Regensburg; Maarten P. Mourits; Wilmar M. Wiersinga // Thyroid;Apr2007, Vol. 17 Issue 4, p357 

    Background:Intravenous methylprednisolone pulses (IVMP) are more efficacious and better tolerated than oral prednisone in Graves' ophthalmopathy (GO) patients. However, acute and severe liver damage has been reported in sporadic cases during IVMP, resulting in fatal acute liver failure in four...

  • Fatty liver in men is associated with high serum levels of small, dense low-density lipoprotein cholesterol. Kaori Hosoyamada; Hirofumi Uto; Yasushi Imamura; Yasunari Hiramine; Eriko Toyokura; Yoshihiro Hidaka; Tomomi Kuwahara; Ken Kusano; Kazuto Saito; Makoto Oketani; Akio Ido; Hirohito Tsubouchi // Diabetology & Metabolic Syndrome;2012, Vol. 4 Issue 1, p34 

    Aims: Our study addressed potential associations between fatty liver and small, dense low-density lipoprotein cholesterol (sd-LDL-C) levels using a cross-sectional analysis. Methods: We enrolled 476 male subjects. Serum sd-LDL-C concentrations were determined using precipitation assays. Results:...

  • A Novel SERPINA1 Mutation Causing Serum Alpha1-Antitrypsin Deficiency. Saunders, Darren N.; Tindall, Elizabeth A.; Shearer, Robert F.; Roberson, Jacquelyn; Decker, Amy; Wilson, Jean Amos; Hayes, Vanessa M. // PLoS ONE;Dec2012, Vol. 7 Issue 12, p1 

    Mutations in the SERPINA1 gene can cause deficiency in the circulating serine protease inhibitor α1-Antitrypsin (α1AT). α1AT deficiency is the major contributor to pulmonary emphysema and liver disease in persons of European ancestry, with a prevalence of 1 in 2500 in the USA. We...

  • Biliary complications after a right-lobe living donor liver transplantation. Yazumi, Shujiro; Chiba, Tsutomu // Journal of Gastroenterology;Sep2005, Vol. 40 Issue 9, p861 

    Right-lobe living donor liver transplantation (RL-LDLT) has become an acceptable procedure for adult patients with end-stage liver disease in this decade. However, biliary complications in RL-LDLT remain a serious problem: the incidence of anastomotic biliary leakage and stricture after RL-LDLT...

  • Quadrennial Review on Liver Transplantation. Ringe, Burckhardt // American Journal of Gastroenterology;Aug1994 Supplement, Vol. 89 Issue 8, pS18 

    Within the last years, liver transplantation has definitely come of age, and evolved to the standard treatment of choice for patients with endstage liver disease, and after ineffective conventional therapy. This development became possible on the basis of intensive interdisciplinary scientific...

  • Contemporary Strategies in the Management of Hepatocellular Carcinoma. Khorsandi, Shirin Elizabeth; Heaton, Nigel // HPB Surgery;2012, Special section p1 

    Liver transplantation is the treatment of choice for selected patients with hepatocellular carcinoma (HCC) on a background of chronic liver disease. Liver resection or locoregional ablative therapies may be indicated for patients with preserved synthetic function without significant portal...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics