Model for End-Stage Liver Disease

Model for End-Stage Liver Disease (MELD) is a reliable measure of mortality risk in patients with end-stage liver disease. It is used by the Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS) to prioritize patients for liver transplantation.

History

The MELD score was initially developed to predict death within three months of surgery in patients who had undergone a Transjugular intrahepatic portosystemic shunt (TIPS) procedure. Later, the MELD score was found to be useful in determining prognosis and prioritizing for receipt of a liver transplant. This score is now used by the United Network for Organ Sharing (UNOS) and the Organ Procurement and Transplantation Network (OPTN) for prioritizing allocation of liver transplants instead of the older Child-Pugh score.

Calculation

The MELD score is calculated using the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. It uses the following formula:

MELD Score = 3.78*ln([serum bilirubin mg/dL]) + 11.2*ln(INR) + 9.57*ln([serum creatinine mg/dL]) + 6.43

Usage

The MELD score is used to predict survival for patients with chronic liver disease. The higher the MELD score, the more urgently the patient needs a liver transplant. MELD scores are often used in conjunction with other medical evidence to determine how urgently a patient needs a liver transplant compared to other patients.

Limitations

While the MELD score is a powerful tool for predicting short-term mortality in patients with end-stage liver disease, it has limitations. It does not take into account the patient's age, cause of liver disease, or presence of conditions such as ascites and encephalopathy. It also does not consider the patient's functional status or quality of life.

See also

• Liver transplantation
• Liver disease
• Child-Pugh score
• Organ transplantation