Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns
The Model for End-stage Liver Disease (MELD) score was developed as a simple, and more objective hepatic score compared to Child-Pugh. It accurately predicts short-term mortality on the liver transplant waiting list, and its three variables: serum bilirubin, creatininemia, and international normalized ratio, highlight the prognostic significance of the interactions between liver and renal functional variables in cirrhotic patients. Recently, MELD alternative forms (sodium MELD, and corrected creatinine MELD), and its combination with estimated glomerular filtration rate (eGFR), have been proposed as more reliable markers. The MELD score has been widely validated in different populations of cirrhotic patients, but it has been suggested that creatinine weighs too heavily on this score. Conclusion: despite some concerns, MELD score is currently useful for guiding liver transplant allocation.