Since the MELD score was introduced, there have been several modifications that may have increased effectiveness in certain situations. The MELD score has been adopted as a biomarker with good effect in other situations where patients with ESLD have a high risk of dying such as surgery, alcoholic hepatitis, acute liver failure, and variceal bleeding. The use of the MELD allocation system has resulted in sicker patients being transplanted with decreased waiting time, thereby decreasing the death rate on the LT waiting list, without an adverse effect on posttransplant outcome. Since 2002, the MELD score has been used to prioritize deceased donor organ allocation for patients listed for liver transplantation (LT) in the USA. The MELD score incorporates serum bilirubin, creatinine, and INR in a mathematical formula. The model for end-stage liver disease (MELD) score was developed and is an accurate biomarker of 90-day mortality in patients with ESLD, essentially measuring how sick a patient is. Previous methods to quantify the risk of death in these patients were subjective. doi: 10.1007/s0042-9.End-stage liver disease (ESLD) due to cirrhosis carries a high mortality. Adult living donor liver transplantation: body mass index and MELD score of recipients are independent risk factors for hospital mortality. Tsui TY, Scherer MN, Schnitzbauer AA, Schlitt HJ, Obed A. Liver transplantation with the Meld system: a prospective study from a single European center. Ravaioli M, Grazi GL, Ballardini G, Cavrini G, Ercolani G, Cescon M, Zanello M, Cucchetti A, Tuci F, Del Gaudio M, Varotti G, Vetrone G, Trevisani F, Bolondi L, Pinna AD. Overview of the MELD score and the UNOS adult liver allocation system. Martin AP, Bartels M, Hauss J, Fangmann J. Liver transplantation in the MELD era: a single-center experience. Sachdev M, Hernandez JL, Sharma P, Douglas DD, Byrne T, Harrison ME, Mulligan D, Moss A, Reddy K, Vargas HE, Rakela J, Balan V. Is living donor liver transplantation cost-effective? J Hepatol. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity. This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2). Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. ![]() We retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival. The impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD.
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