Model for End-stage Liver Disease.

Area of Science:

• Hepatology
• Transplantation Medicine
• Medical Informatics

Background:

• The Model for End-Stage Liver Disease (MELD) score was initially developed to predict survival after transjugular intrahepatic portosystemic shunt (TIPS).
• It has since become a crucial tool for predicting mortality in patients with end-stage liver disease (ESLD).
• Since 2002, the MELD score has been globally adopted for liver transplant listing and allocation.

Purpose of the Study:

• To review the established role and accuracy of the MELD score in predicting mortality and guiding liver transplantation.
• To highlight the MELD score's utility across various liver-related conditions beyond ESLD.
• To discuss the limitations of the current MELD score and ongoing efforts for its refinement.

Main Methods:

• The MELD score utilizes three objective variables: serum bilirubin, serum creatinine, and international normalized ratio (INR).
• Its predictive accuracy has been validated across diverse clinical scenarios including alcoholic hepatitis, variceal hemorrhage, infections, and post-surgical outcomes in cirrhosis.
• The study reviews existing literature and clinical application data of the MELD score.

Main Results:

• The MELD score accurately predicts mortality in a majority of patients with end-stage liver disease.
• It facilitates prioritizing sicker patients for liver transplantation, irrespective of their waiting time.
• The score demonstrates predictive value in various complications of liver disease and post-operative settings.

Conclusions:

• The MELD score is a robust predictor of mortality and a cornerstone of liver allocation policy worldwide.
• Despite its accuracy, the MELD score has limitations, with inaccuracies in 15-20% of cases.
• Ongoing research aims to improve the MELD score, but it remains the current standard for liver allocation.