The Model for
End-Stage Liver Disease (MELD) score incorporates serum
bilirubin,
creatinine, and the international normalized ratio (INR) into a formula that provides a continuous variable that is a very accurate predictor of 90-day mortality in patients with
cirrhosis. It is currently utilized in the United States to prioritize deceased donor organ allocation for patients listed for
liver transplantation. The MELD score is superior to other prognostic models in patients with
end-stage liver disease, such as the Child-Turcotte-Pugh score, since it uses only objective criteria, and its implementation in 2002 led to a sharp reduction in the number of people waiting for
liver transplant and reduced mortality on the waiting list without affecting posttransplant survival. Although mainly adopted for use in patients waiting for
liver transplant, the MELD score has also proved to be an effective predictor of outcome in other situations, such as patients with
cirrhosis going for surgery and patients with
fulminant hepatic failure or
alcoholic hepatitis. Several variations of the original MELD score, involving the addition of serum
sodium or looking at the change in MELD over time, have been examined, and these may slightly improve its accuracy. The MELD score does have limitations in situations where the INR or
creatinine may be elevated due to reasons other than
liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from
liver transplantation. The application of the MELD score in prioritizing patients for
liver transplantation has been successful, but further studies and legislation are required to ensure a fair and equitable system.