The MELD Score fulfilled their criteria and was accepted as the score to prioritize organ allocation for liver transplantation. The score was originally called the Mayo End-Stage Liver Disease (MELD) model and was shown to be superior to the Child-Turcotte-Pugh score.Īt about the time we published the score, the Institute of Medicine determined that organ allocation for liver transplantation should no longer be based on waiting time but on an objective score that reflected severity of liver disease. We developed a score based on these variables and demonstrated it predicted survival in a wide variety of patients with cirrhosis not undergoing TIPS. My colleague in statistics, Mike Malinchoc, and I studied laboratory variables prior to the procedure and identified INR, serum creatinine, serum bilirubin and etiology of cirrhosis being predictive of survival. Why did you develop the MELD Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?įollowing a trans-jugular intrahepatic portosystemic shunt (TIPS) procedure for complications of portal hypertension, some patients do well and others fare poorly. Therefore, in principle, the score should only be applied after these reversible conditions have been treated, according to the authors ( Kamath 2007). One of the exclusion criteria for the original data set was absence of acute reversible conditions such as spontaneous bacterial peritonitis or prerenal azotemia secondary to dehydration.
Several conditions are “standard MELD exceptions” and receive a different score (see Next Steps > Critical Actions): hepatocellular carcinoma, hepatopulmonary syndrome, portopulmonary hypertension, familial amyloid polyneuropathy, primary hyperoxaluria, cystic fibrosis, hilar cholangiocarcinoma and hepatic artery thrombosis.Currently, there is no modification in the score for patients on anticoagulation (given their INR may be elevated).MELD can be used on any patient with end stage liver disease irrespective of cirrhosis etiology.Values should be no more than 48 hours old.It is preferable to using the calculator to calculate the MELD as there are several caveats relating to minimum and maximum values assigned in the MELD.The MELD was updated in January 2016 and now includes serum sodium level.Scores range from 6 to 40, with higher scores correlating with increased severity of liver dysfunction and higher three-month mortality.The MELD Score predicts three-month survival in patients (age 12+) with liver cirrhosis.
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