![]() In 1996, a consensus conference mandating need for minimal criteria for listing the patients for liver transplantation (LT) introduced the Child–Pugh–Turcotte (CTP) score for liver allocation. This approach had the potential of ‘gaming’ the system by keeping the patients in ICU in order to be transplanted. Until, a better score is developed, liver allocation would continue based on the currently used MELD score.Īllocation of organs for liver transplantation in the United States in the 1980s and early 1990s was prioritized based on the level of care required by the patient: hospitalized patients in the intensive care unit, hospitalized patients on the regular floor, and outpatient care. Over the last decade, many efforts have been made to further improve and refine MELD score. Although, MELD score is closest to the ideal score, there are some limitations including its inaccuracy in predicting survival in 15–20% cases. MELD score has also been shown to be accurate predictor of survival amongst patients with alcoholic hepatitis, following variceal hemorrhage, infections in cirrhosis, after surgery in patients with cirrhosis including liver resection, trauma, and hepatorenal syndrome (HRS). ![]() Since 2002, MELD score using 3 objective variables (serum bilirubin, serum creatinine, and institutional normalized ratio) has been used worldwide for listing and transplanting patients with end-stage liver disease allowing transplanting sicker patients first irrespective of the wait time on the list. ![]() Using the MELD score, patients are assigned a score from 6 to 40, which equates to an estimated 3-month survival rate from 90% to 7%, respectively.Model for end-stage liver disease (MELD) score, initially developed to predict survival following transjugular intrahepatic portosystemic shunt was subsequently found to be accurate predictor of mortality amongst patents with end-stage liver disease. The reason for this conversion is that the natural logarithm of 1 is 0, and any value below 1 would yield a negative result. if bilirubin is 0.9, a value of 1.0 is used).
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