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Updated: May 28, 2026
Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
The influence of laboratory-induced MELD score differences on liver allocation: more reality than myth
J N Schouten1, S Francque, H Van Vlierberghe
1Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium. j.schouten@erasmusmc.nl
Background:
Liver allocation in Eurotransplant (ET) is based on the MELD score. Interlaboratory MELD score differences in INR and creatinine determination have been reported. The clinical implication of this observation has not been demonstrated.
Methods:
MELD scores were calculated in 66 patients with liver cirrhosis using bilirubin, creatinine, and INR analyzed in six liver transplant centers. Based on allocation results of ET, patients transplanted from December 2006 to June 2007 were divided according to MELD score in four groups. For each group, the influence of the match MELD on the probability of receiving a transplant was studied (Cox proportional hazards model).
Results:
Laboratory-dependent significant differences in MELD score were demonstrated. Cox proportional hazards model showed a significant association between MELD score and the probability of organ allocation. The unadjusted hazard ratio for receiving a liver transplant was significantly different between group 2 and group 4 (group 2: MELD 19-24; group 4: MELD > 30).
Conclusion:
Laboratory-dependent significant differences in MELD score were observed between the six transplant centers. We demonstrated a significant association between the MELD score and the probability of organ allocation. The observed interlaboratory variation might yield a significant difference in organ allocation in patients with high MELD scores.
Insights
Laboratory variations in MELD scores affect liver transplant allocation. Differences in MELD scores between centers significantly impact a patient's probability of receiving a liver transplant, especially for those with high scores.
Area of Science:
- Hepatology
- Transplantation Medicine
- Clinical Chemistry
Background:
- Liver allocation in Eurotransplant (ET) relies on the Model for End-Stage Liver Disease (MELD) score.
- Previous reports indicated interlaboratory variations in INR and creatinine measurements.
- The clinical impact of these MELD score discrepancies remained unquantified.
Purpose of the Study:
- To investigate the impact of interlaboratory MELD score variations on liver transplant organ allocation.
- To determine if laboratory differences in MELD score calculations influence transplant probability.
Main Methods:
- MELD scores were calculated for 66 liver cirrhosis patients across six transplant centers.
- Patients were stratified into four groups based on MELD score post-allocation.
- Cox proportional hazards models analyzed the association between MELD score and transplant probability.
Main Results:
- Significant laboratory-dependent MELD score differences were observed between centers.
- A significant association was found between MELD score and the likelihood of organ allocation.
- The unadjusted hazard ratio for receiving a transplant differed significantly between MELD score groups (e.g., MELD 19-24 vs. >30).
Conclusions:
- Interlaboratory variations in MELD score determination are significant across transplant centers.
- MELD score is significantly associated with the probability of liver organ allocation.
- These variations may lead to disparities in organ allocation, particularly for patients with high MELD scores.
