title: Model for End-stage Liver Disease.
abstract: Model for end-stage liver disease (MELD) score, initially developed to predict survival following transjugular intrahepatic portosystemic shunt was subsequently found to be accurate predictor of mortality amongst patents with end-stage liver disease. Since 2002, MELD score using 3 objective variables (serum bilirubin, serum creatinine, and institutional normalized ratio) has been used worldwide for listing and transplanting patients with end-stage liver disease allowing transplanting sicker patients first irrespective of the wait time on the list. MELD score has also been shown to be accurate predictor of survival amongst patients with alcoholic hepatitis, following variceal hemorrhage, infections in cirrhosis, after surgery in patients with cirrhosis including liver resection, trauma, and hepatorenal syndrome (HRS). Although, MELD score is closest to the ideal score, there are some limitations including its inaccuracy in predicting survival in 15-20% cases. Over the last decade, many efforts have been made to further improve and refine MELD score. Until, a better score is developed, liver allocation would continue based on the currently used MELD score.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
keywords: AH, alcoholic hepatitis; BAR, balance risk; CTP, Child–Pugh–Turcotte; Cirrhosis; DFI, discriminate function index; EDC, extended donor criteria; ESLD, end-stage liver disease; FHF, fulminant hepatic failure; GFR, glomerular filtration rate; HVPG, hepatic venous pressure gradient; LT, liver transplantation; Liver transplantation; MDRD, modification of diet in renal disease; MELD; MELD, model for end-stage liver disease; MLP, multi-layer perceptron; QALY, quality adjusted life years; SLK, simultaneous liver kidney transplantation; SOFA, sequential organ failure assessment; SOFT, survival outcomes following transplantation; TIPS, transjugular intrahepatic portosystemic; UKELD, UK end stage liver disease score; UNOS, United Network for Organ Sharing; VH, variceal hemorrhage; deMELD, drop-out equivalent MELD