Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Hepatology International
Published in: Hepatology International 3/2015

01-07-2015 | Review Article

Model for end-stage liver disease score and MELD exceptions: 15 years later

Authors: Sumeet K. Asrani, Patrick S. Kamath

Published in: Hepatology International | Issue 3/2015

Login to get access

Abstract

The model for end-stage liver disease (MELD) score has been used as an objective scale of disease severity for management of patients with end-stage liver disease; it currently serves as the basis of an urgency-based organ-allocation policy in several countries. Implementation of the MELD score led to a reduction in waiting-list registration and waiting-list mortality and an increase in the number of deceased-donor transplants without adversely affecting long-term outcomes after liver transplantation (LT). The MELD score has been used for management of non-transplant patients with chronic liver disease. MELD exceptions serve as a mechanism to advance the needs of subsets of patients with liver disease not adequately addressed by MELD-based organ allocation. Several models have been proposed to refine and improve the MELD score as the environment within which it operates continues to evolve toward transplantation for sicker patients. The MELD score continues to serve and be used as a template to improve upon as an objective gauge of disease severity and as a metric enabling optimization of allocation of scarce donor organs for LT.
Literature
1.
Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–871PubMedCrossRef
2.
Freeman RB Jr, Edwards EB. Liver transplant waiting time does not correlate with waiting list mortality: implications for liver allocation policy. Liver Transpl 2000;6:543–552PubMedCrossRef
3.
Freeman RB Jr. Is waiting time a measure of access to liver transplantation? Is shorter necessarily better? Hepatology 2007;46:602–603PubMedCrossRef
4.
Freeman RB Jr. The model for end-stage liver disease comes of age. Clin Liver Dis 2007;11:249–263PubMedCrossRef
5.
Wiesner R, Lake JR, Freeman RB, et al. Model for end-stage liver disease (MELD) exception guidelines. Liver Transpl 2006;12:S85–S87PubMedCrossRef
6.
National Research Council. Organ procurement and transplantation: assessing current policies and the potential impact of the DHHS final rule. Washington: The National Academies Press; 1999
7.
Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–470PubMedCrossRef
8.
9.
Freeman RB Jr, Wiesner RH, Harper A, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 2002;8:851–858PubMedCrossRef
10.
Olthoff KM, Brown RS Jr, Delmonico FL, et al. Summary report of a national conference: evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA. Liver Transpl 2004;10:A6–A22PubMedCrossRef
11.
Freeman RB, Wiesner RH, Edwards E, et al. Results of the first year of the new liver allocation plan. Liver Transpl 2004;10:7–15PubMedCrossRef
12.
Austin MT, Poulose BK, Ray WA, et al. Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality? Arch Surg 2007;142:1079–1085PubMedCrossRef
13.
Lim YS, Larson TS, Benson JT, et al. Serum sodium, renal function, and survival of patients with end-stage liver disease. J Hepatol 2010;52:523–528PubMedCrossRef
14.
Freeman RB, Harper A, Edwards EB. Excellent liver transplant survival rates under the MELD/PELD system. Transplant Proc 2005;37:585–588PubMedCrossRef
15.
Kanwal F, Dulai GS, Spiegel BM, et al. A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras. Aliment Pharmacol Ther 2005;21:169–177PubMedCrossRef
16.
Thuluvath PJ, Guidinger MK, Fung JJ, et al. Liver transplantation in the United States, 1999–2008. Am J Transplant 2010;10:1003–1019PubMedCrossRef
17.
Kim HJ, Larson JJ, Lim YS, et al. Impact of MELD on waitlist outcome of retransplant candidates. Am J Transplant 2010;10:2652–2657PubMedCrossRef
18.
Benckert C, Quante M, Thelen A, et al. Impact of the MELD allocation after its implementation in liver transplantation. Scand J Gastroenterol 2011;46(7–8):941–948PubMedCrossRef
19.
Nagler E, Van Vlierberghe H, Colle I, et al. Impact of MELD on short-term and long-term outcome following liver transplantation: a European perspective. Eur J Gastroenterol Hepatol 2005;17:849–856PubMedCrossRef
20.
Palmiero HO, Kajikawa P, Boin IF, et al. Liver recipient survival rate before and after model for end-stage liver disease implementation and use of donor risk index. Transplant Proc 2010;42:4113–4115PubMedCrossRef
21.
Mattos AZ, Mattos AA, Sacco FK, et al. Analysis of the survival of cirrhotic patients enlisted for liver transplantation in the pre- and post-meld era in southern Brazil. Arq Gastroenterol 2014;51:46–52PubMedCrossRef
22.
Quante M, Benckert C, Thelen A, et al. Experience since MELD implementation: How does the new system deliver? Int J Hepatol 2012;2012:264015. doi:10.​1155/​2012/​264015
23.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006;44:217–231PubMedCrossRef
24.
Yantorno SE, Kremers WK, Ruf AE, et al. MELD is superior to King’s college and Clichy’s criteria to assess prognosis in fulminant hepatic failure. Liver Transpl 2007;13:822–828PubMedCrossRef
25.
Kremers WK, van IJperen M, Kim WR, et al. MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients. Hepatology 2004;39:764–769PubMedCrossRef
26.
Alessandria C, Ozdogan O, Guevara M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology 2005;41:1282–1289PubMedCrossRef
27.
Northup PG, Wanamaker RC, Lee YD, et al. Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg 2005;242:244–251PubMedCentralPubMedCrossRef
28.
Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 2007;132:1261–1269
29.
Dunn W, Jamil LH, Brown LS, et al. MELD accurately predicts mortality in patients with alcoholic hepatitis. Hepatology 2005;41:353–358PubMedCrossRef
30.
Kim MS, Kato TS, Farr M, et al. Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 2013;61:2253–2261PubMedCentralPubMedCrossRef
31.
Deo SV, Daly RC, Altarabsheh SE, et al. Predictive value of the model for end-stage liver disease score in patients undergoing left ventricular assist device implantation. ASAIO J 2013;59:57–62PubMedCrossRef
32.
Fink MA, Angus PW, Gow PJ, et al. Liver transplant recipient selection: MELD vs. clinical judgment. Liver Transpl 2005;11:621–626PubMedCrossRef
33.
34.
Charlton MR, Wall WJ, Ojo AO, et al. Report of the first international liver transplantation society expert panel consensus conference on renal insufficiency in liver transplantation. Liver Transpl 2009;15:S1–S34PubMedCrossRef
35.
Eason JD, Gonwa TA, Davis CL, et al. Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK). Am J Transplant 2008;8:2243–2251PubMedCrossRef
36.
Sharma P, Welch K, Eikstadt R, et al. Renal outcomes after liver transplantation in the model for end-stage liver disease era. Liver Transpl 2009;15:1142–1148PubMedCrossRef
37.
Nair S, Verma S, Thuluvath PJ. Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation. Hepatology 2002;35:1179–1185PubMedCrossRef
38.
Francoz C, Glotz D, Moreau R, et al. The evaluation of renal function and disease in patients with cirrhosis. J Hepatol 2010;52:605–613PubMedCrossRef
39.
Francoz C, Prie D, Abdelrazek W, et al. Inaccuracies of creatinine and creatinine-based equations in candidates for liver transplantation with low creatinine: impact on the model for end-stage liver disease score. Liver Transpl 2010;16:1169–1177PubMedCrossRef
40.
Cholongitas E, Marelli L, Kerry A, et al. Different methods of creatinine measurement significantly affect MELD scores. Liver Transpl 2007;13:523–529PubMedCrossRef
41.
Arjal R, Trotter JF. International normalized ratio of prothrombin time in the model for end-stage liver disease score: an unreliable measure. Clin Liver Dis 2009;13:67–71PubMedCrossRef
42.
Trotter JF, Olson J, Lefkowitz J, et al. Changes in international normalized ratio (INR) and model for endstage liver disease (MELD) based on selection of clinical laboratory. Am J Transplant 2007;7:1624–1628PubMedCrossRef
43.
Bellest L, Eschwege V, Poupon R, et al. A modified international normalized ratio as an effective way of prothrombin time standardization in hepatology. Hepatology 2007;46:528–534PubMedCrossRef
44.
Tripodi A, Chantarangkul V, Primignani M, et al. The international normalized ratio calibrated for cirrhosis (INR(liver)) normalizes prothrombin time results for model for end-stage liver disease calculation. Hepatology 2007;46:520–527PubMedCrossRef
45.
Porte RJ, Lisman T, Tripodi A, et al. The international normalized ratio (INR) in the MELD score: problems and solutions. Am J Transplant 2010;10:1349–1353PubMedCrossRef
46.
Biggins SW, Bambha K. MELD-based liver allocation: Who is underserved? Semin Liver Dis 2006;26:211–220PubMedCrossRef
47.
Heuman DM, Mihas AA, Habib A, et al. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 2007;13:30–37PubMedCrossRef
48.
Marlar RA. Determining the model for end-stage liver disease with better accuracy: neutralizing the international normalized ratio pitfalls. Hepatology 2007;46:295–296PubMedCrossRef
49.
Kim WR, Stock PG, Smith JM, et al. OPTN/SRTR 2011 annual data report: liver. Am J Transplant 2013;13(Suppl 1):73–102PubMedCrossRef
50.
Davis CL. Kidney failure in liver transplantation: it is time for action. Am J Transplant 2006;6:2533–2534PubMedCrossRef
51.
Gonwa TA, McBride MA, Anderson K, et al. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am J Transplant 2006;6:2651–2659PubMedCrossRef
52.
53.
Gentry SE, Massie AB, Cheek SW, et al. Addressing geographic disparities in liver transplantation through redistricting. Am J Transplant 2013;13:2052–2058PubMedCrossRef
54.
55.
Sharma P, Schaubel DE, Gong Q, et al. End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates. Hepatology 2012;55:192–198PubMedCentralPubMedCrossRef
56.
Axelrod DA, Dzebisashvili N, Lentine K, et al. Assessing variation in the costs of care among patients awaiting liver transplantation. Am J Transplant 2014;14:70–78PubMedCrossRef
57.
Davis CL. Impact of implementation of the MELD scoring system on the prevalence and incidence of chronic renal disease following liver transplantation. Liver Transpl 2006;12:707–709PubMedCrossRef
58.
Machicao VI, Srinivas TR, Hemming AW, et al. Impact of implementation of the MELD scoring system on the prevalence and incidence of chronic renal disease following liver transplantation. Liver Transpl 2006;12:754–761PubMedCrossRef
59.
Sharma P, Schaubel DE, Guidinger MK, et al. Impact of MELD-based allocation on end-stage renal disease after liver transplantation. Am J Transplant 2011;11:2372–2378PubMedCentralPubMedCrossRef
60.
Lai JC, Terrault NA, Vittinghoff E, et al. Height contributes to the gender difference in wait-list mortality under the MELD-based liver allocation system. Am J Transplant 2010;10:2658–2664PubMedCentralPubMedCrossRef
61.
Moylan CA, Brady CW, Johnson JL, et al. Disparities in liver transplantation before and after introduction of the MELD score. JAMA 2008;300:2371–2378PubMedCentralPubMedCrossRef
62.
Myers RP, Shaheen AA, Aspinall AI, et al. Gender, renal function, and outcomes on the liver transplant waiting list: assessment of revised MELD including estimated glomerular filtration rate. J Hepatol 2011;54:462–470PubMedCrossRef
63.
64.
65.
Allen AM, Hay JE. Review article: the management of cirrhosis in women. Aliment Pharmacol Ther 2014;40:1146–1154PubMedCrossRef
66.
Pomfret EA, Washburn K, Wald C, et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl 2010;16:262–278PubMedCrossRef
67.
Thuluvath PJ, Maheshwari A, Thuluvath NP, et al. Survival after liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease and pre-model for end-stage liver disease eras and the independent impact of hepatitis C virus. Liver Transpl 2009;15:754–762PubMedCrossRef
68.
Washburn K. Model for end-stage liver disease and hepatocellular carcinoma: a moving target. Transplant Rev (Orlando) 2010;24:11–17CrossRef
69.
Washburn K, Edwards E, Harper A, et al. Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system. Am J Transplant 2010;10:1643–1648PubMedCrossRef
70.
Northup PG, Intagliata NM, Shah NL, et al. Excess mortality on the liver transplant waiting list: unintended policy consequences and model for end-stage liver disease (MELD) inflation. Hepatology 2015;61:285–291
71.
Francoz C, Belghiti J, Castaing D, et al. Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system. Liver Transpl 2011;17:1137–1151PubMedCrossRef
72.
Goldberg DS, Batra S, Sahay S, et al. MELD exceptions for portopulmonary hypertension: current policy and future implementation. Am J Transplant 2014;14:2081–20817PubMedCentralPubMedCrossRef
73.
Goldberg D, French B, Thomasson A, et al. Waitlist survival of patients with primary sclerosing cholangitis in the model for end-stage liver disease era. Liver Transpl 2011;17:1355–1363PubMedCentralPubMedCrossRef
74.
Goldberg DS, Krok K, Batra S, et al. Impact of the hepatopulmonary syndrome MELD exception policy on outcomes of patients after liver transplantation: an analysis of the UNOS database. Gastroenterology 2014;146:1256–1265.e1PubMedCentralPubMedCrossRef
75.
Toso C, Dupuis-Lozeron E, Majno P, et al. A model for dropout assessment of candidates with or without hepatocellular carcinoma on a common liver transplant waiting list. Hepatology 2012;56:149–156PubMedCrossRef
76.
77.
Schuetz C, Dong N, Smoot E, et al. HCC patients suffer less from geographic differences in organ availability. Am J Transplant 2013;13:2989–2995PubMedCrossRef
78.
Toso C, Mazzaferro V, Bruix J, et al. Toward a better liver graft allocation that accounts for candidates with and without hepatocellular carcinoma. Am J Transplant 2014;14:2221–2227PubMedCrossRef
79.
Freeman RB Jr. Model for end-stage liver disease (MELD) for liver allocation: a 5-year score card. Hepatology 2008;47:1052–1057PubMedCrossRef
80.
Lake JR. MELD–an imperfect, but thus far the best, solution to the problem of organ allocation. J Gastrointestin Liver Dis 2008;17:5–7PubMed
81.
Sharma P, Schaubel DE, Sima CS, et al. Re-weighting the model for end-stage liver disease score components. Gastroenterology 2008;135:1575–1581PubMedCrossRef
82.
Leise MD, Kim WR, Kremers WK, et al. A Revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology 2011;140:1952–1990PubMedCrossRef
83.
Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359:1018–1026PubMedCentralPubMedCrossRef
84.
Barber K, Madden S, Allen J, et al. Elective liver transplant list mortality: development of a United Kingdom end-stage liver disease score. Transplantation 2011;92:469–476PubMedCrossRef
85.
Freeman RB Jr. Variation in health care delivery: the example of exception awards in liver transplantation. Am J Transplant 2011;11:2271–2272PubMedCrossRef
Metadata
Title
Model for end-stage liver disease score and MELD exceptions: 15 years later
Authors
Sumeet K. Asrani
Patrick S. Kamath
Publication date
01-07-2015
Publisher
Springer India
Published in
Hepatology International / Issue 3/2015
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI
https://doi.org/10.1007/s12072-015-9631-3

Other articles of this Issue 3/2015

Hepatology International 3/2015 Go to the issue

Original Article

Acute kidney injury in hepatitis B-related acute-on-chronic liver failure without preexisting liver cirrhosis

Original Article

β-Blocker therapy ameliorates hypersplenism due to portal hypertension in children

Editorial

Can hypersplenism secondary to portal hypertension be treated by non-selective beta blockers?

Review Article

Definition of ACLF and inclusion criteria for extra-hepatic organ failure

Original Article

Sustained virologic response to standard interferon or pegylated interferon and ribavirin in patients with hepatitis C virus genotype 5: systematic review and meta-analysis of ten studies and 423 patients

Original Article

Analysis of adult 20-year survivors after liver transplantation
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits