Are MELD and MELDNa Still Reliable Tools to Predict Mortality on the Liver Transplant Waiting List?

Abstract

Liver transplantation is the only curative treatment for end-stage liver disease. Unfortunately, the scarcity of donor organs and the increasing pool of potential recipients limit access to this life-saving procedure. Allocation should account for medical and ethical factors, ensuring equal access to transplantation regardless of recipient’s gender, race, religion, or income. Based on their short-term prognosis prediction, model for end-stage liver disease (MELD) and MELD sodium (MELDNa) have been widely used to prioritize patients on the waiting list for liver transplantation resulting in a significant decrease in waiting list mortality/removal. Recent concern has been raised regarding the prognostic accuracy of MELD and MELDNa due, in part, to changes in recipients’ profile such as body mass index, comorbidities, and general condition, including nutritional status and cause of liver disease, among others. This review aims to provide a comprehensive view of the current state of MELD and MELDNa advantages and limitations and promising alternatives. Finally, it will explore future options to increase the donor pool and improve donor-recipient matching.

Women Are Also Disadvantaged in Accessing Transplant Outside the United States: Analysis of the Spanish Liver Transplantation Registry

“…The Spanish LT community should take this opportunity to engage in appropriate data collection, so that Registry studies can offer solid evidence as to how our excellent system performs. No other relevant predictors of WL mortality [ 33 ] have been explored, due to the retrospective nature of the study. Finally, there are, still nowadays, significant differences in WL times and donation rates between regions in Spain.…”

“…Our aim was to describe sex-related differences in access to LT in a system with short waiting times. All adult patients registered in the RETH-Spanish Liver Transplant Registry (2000-2022 for LT were included. Baseline demographics, presence of hepatocellular carcinoma, cause and severity of liver disease, time on the waiting list (WL), access to transplantation, and reasons for removal from the WL were assessed.…”

Applicability of Child-Turcotte-Pugh Score in Anticipating Post-ERCP Adverse Events in Patients With Cirrhosis

“…In compensated liver disease, markers of portal pressure are of utmost value, while in its decompensated counterpart, markers of circulatory dysfunction provide more accurate prognostic value 23,27 . Compared with the Child-Pugh score, MELD has the advantages of being rigorously validated, proven to significantly reduce mortality, and most importantly, rely on objective and easily obtainable laboratory markers 24 . The latter of which is pertinent to policy-making practices among institutions concerned with liver transplantation.…”

“…From a methodological perspective, the Child-Pugh is considered primitive compared with its Model for End-stage Liver Disease (MELD) and Albumin-Bilirubin counterparts; both of which demonstrate superior prognostic accuracy. [21][22][23][24][25] The Child-Pugh, while being the historic progenitor for all prognostic models associated with liver disease, suffers from a number of methodological limitations. 19,26,27 Firstly, it utilizes data-driven cutoff points.…”

Overcoming the hurdles of steatotic grafts in liver transplantation: Insights into survival and prognostic factors

“…Liver transplantation (LT) is currently the sole curative approach for patients with end-stage liver disease. [1] The past decade has seen a global surge in the utilization of marginal donors, driven by a marked rise in the number of recipients and an ensuing scarcity of suitable organs. [2] One group of these marginal donors includes those with steatosis.…”