Model for end-stage liver disease (MELD) and allocation of donor livers.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Wiesner
Russell
R
Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. rwiesner@mayo.edu
Edwards
Erick
E
Freeman
Richard
R
Harper
Ann
A
Kim
Ray
R
Kamath
Patrick
P
Kremers
Walter
W
Lake
John
J
Howard
Todd
T
Merion
Robert M
RM
Wolfe
Robert A
RA
Krom
Ruud
R
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000379:methods*; D012720:Severity of Illness Index; D014850:Waiting Lists