MELD may not be the better system for organ allocation in liver transplantation patients in Singapore
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Updated: Aug 2, 2026
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Y M Lee1, M Fernandez, M Da Costa
1Department of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
Introduction:
The Model for End-Stage Liver Disease (MELD) score is a good predictor of mortality on the liver transplant waiting list and is the current system of organ allocation in the USA. However, a higher MELD may be associated with poorer outcome post-liver transplantation. The aim of this study was to determine if MELD should be implemented as the system for organ allocation for liver transplantation in Singapore.
Methods:
There were 46 adult patients who underwent primary liver transplantation at the National University Hospital, Singapore from January 1996 to December 2002. We applied the MELD score to patients who were transplanted and looked for a correlation with survival post-transplant. Patients were followed-up until the most recent visit or death. Survival analysis was performed using Cox regression and Kaplan-Meier method.
Results:
The mean age at transplant was 52.7 (SD 2.34) years. The majority of the patients transplanted had Hepatitis B (43 percent). The median MELD score at transplantation was 17 (7-42) and the median Child's score was 11 (6-15). There was a significant correlation between pre-transplant MELD and survival at six months (p-value is 0.037, 95 percent confidence interval [CI] is 1.004-1.13) but not at one year (p-value is 0.065, 95 percent CI is 0.99-1.12). There were no differences in the pre-transplant MELD (odds-ratio [OR] 1, 95 percent CI 0.9-1) as well as survival for patients with and without Hepatitis B (OR 0.72, 95 percent CI 0.22-2.35).
Conclusion:
MELD allows livers to be allocated to the patients with the greatest medical urgency but its influence on post-transplant survival should be further clarified so that post-transplant survival is not compromised.
Insights
The Model for End-Stage Liver Disease (MELD) score predicts short-term liver transplant survival. Further research is needed to clarify MELD
Area of Science:
- Hepatology
- Transplantation Medicine
- Medical Informatics
Background:
- The Model for End-Stage Liver Disease (MELD) score is a key tool for liver transplant waiting list mortality prediction and organ allocation in the USA.
- A higher MELD score may indicate poorer outcomes following liver transplantation.
- The study investigates the potential implementation of the MELD score for liver organ allocation in Singapore.
Purpose of the Study:
- To evaluate the correlation between pre-transplant MELD scores and post-liver transplantation survival.
- To determine the suitability of the MELD score system for liver organ allocation in Singapore.
Main Methods:
- Retrospective analysis of 46 adult patients undergoing primary liver transplantation at National University Hospital, Singapore (January 1996 - December 2002).
- Application of the MELD score to assess pre-transplant patient urgency.
- Survival analysis using Cox regression and Kaplan-Meier methods, with follow-up until the most recent visit or death.
Main Results:
- The median pre-transplant MELD score was 17 (range 7-42).
- A significant correlation was observed between pre-transplant MELD and six-month post-transplant survival (p=0.037).
- No significant correlation was found between pre-transplant MELD and one-year survival (p=0.065), nor were there differences in MELD or survival based on Hepatitis B status.
Conclusions:
- While the MELD score effectively prioritizes patients with the greatest medical urgency for liver allocation.
- Its impact on post-transplant survival requires further investigation to ensure patient outcomes are not compromised.
- Clarification is needed before widespread implementation for liver allocation in Singapore.
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