![]() 18 Despite this, those with ACLF grade 3 are less likely to get transplanted. 15– 17 In fact, ACLF grade 3 has been shown to have higher mortality compared with patients listed as status 1a, independent of their MELD score. ACLF is a distinct entity characterized by systemic inflammation and the development of organ failures leading to increased mortality without liver transplantation. The MELD-Na score was developed to predict mortality in decompensated cirrhosis but does not accurately predict risk in those with acute-on-chronic liver failure (ACLF). 13 In addition, the cutoff of serum creatinine level in the MELD-Na score has been called into question because it caps at 4 mg/dL implying similar mortality among those with higher creatinine values and regardless of whether they are on dialysis. 12 In fact, 1 study of over 90,000 participants demonstrated that women were 20% less likely to be transplanted than men despite having a higher mortality. 11 Similarly, women have less muscle mass compared with male counterparts and, therefore, have reduced creatinine levels disadvantaging their MELD-Na score prioritization on the waitlist. 9, 10 Individuals with lower muscle mass (ie, sarcopenia) may have lower serum creatinine levels inaccurately reflecting their true renal function. The inclusion of serum creatinine into the score imprecisely reflects true renal function. The MELD-Na score also disadvantages certain populations. As the prevalence of hepatitis C declines and the incidence of nonalcoholic fatty liver disease and alcohol-associated liver disease increases, the discriminative ability of MELD-Na to predict mortality has diminished. The MELD-Na score was developed when hepatitis C was the most common indication for transplantation. ![]() Recent studies demonstrate a reducing predictive ability of the MELD-Na score with the changing epidemiology of liver diseases. It is a dynamic score that changes over time. 1 The Final Rule prompted the need for a validated objective score for liver transplant prioritization with the aims of eliminating subjective bias.ĭespite its improved predictive ability of mortality in cirrhosis, MELD-Na still has limitations. In 2000, the Final Rule, which was devised by the United States Department of Health and Human Services, sought to ensure justice by allocating organs equitably across geographic regions and prioritizing transplantation based on medical urgency defined by objective standardized criteria. In addition, the subjective components of the CTP score, namely, the presence and degree of ascites or encephalopathy, allowed for inappropriately scoring the severity of a patient's condition to benefit his or her position on the waitlist. For example, it allowed for patients to be admitted into the hospital to increase their priority on the waiting list even without a true indication for admission. However, these methods of prioritization allowed for manipulation of the system through loopholes, which led to unfair prioritization of patients on the waiting list. Before the inception of the MELD score, priority on the liver transplant waiting list was based on hospitalization status, time on the waitlist, and eventually the Child-Turcotte-Pugh (CTP) score and its iterations. We only have one hour to find you if we are unable to locate you, the liver will go the next person on the list.Understanding the evolution of MELD is key to learning transplant allocation policy. If we do not have current information, the team may have trouble finding you when it is your turn to receive a transplant. It is a good idea to keep the name and phone number of your transplant coordinator handy so that you can call with any new information. ![]() You must notify the team if there has been a change in your address, insurance carrier, phone number, or medical condition. It is extremely important that the transplant team has current information on you.
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