MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

“…While there is no controversy in the current stratification of patients according to tumour burden and cancer related symptoms [9,10] in prognosis prediction, the evaluation of the underlying liver function already induced to abandon the Child-Pugh classification [11] in the last BCLC version; this aspect deserved again an update. Decompensation of liver disease (jaundice, ascites, encephalopathy) reflects non-preserved liver function irrespective of the Child-Pugh or MELD points [12,13], for which several improvements have been proposed [14], but compensated liver function could be stratified with additional granularity by using the Albumin-Bilirubin (ALBI) score [15][16][17], while also adding AFP concentration irrespective of tumour burden [18,19]. These parameters are now included in the 2022 BCLC model (Figure 1), but while they may impact prognosis, they may not abolish the treatment benefit if the degree of liver dysfunction does not exceed the established selection criteria for an optimal outcome.…”

Hypoalbuminemia Is a Hepatocellular Carcinoma Independent Risk Factor for Tumor Progression in Low-Risk Bridge to Transplant Candidates

“…Albumin was recently shown to play a tumor suppressor role in HCC by suppressing migration and invasion in HCC cell lines [ 20 ]. Albumin was also recently incorporated into the MELD 3.0 score [ 21 ] and our results suggest these changes may improve MELD-based prognosis of HCC progression compared to the MELD-Na. Beyond direct effects of albumin on HCC biology, the role of prostaglandin E2-mediated depletion of albumin stores in advancing CAID and its role in systemic immune suppression are becoming clearer [ 11 , 22 , 23 ].…”

Proposing a Framework to Assess the Methodological Quality of Prognostic Models

“…The liver transplantation (LT) community is already familiar with this concept. Recently, Kim et al showed that “MELD 3.0 correctly reclassified a net of 8.8% of decedents to a higher MELD tier, affording them a meaningfully higher chance of transplantation, particularly in women.” ( 8 ) Furthermore, the decision curve analysis helped a multinational cohort study of consecutive adult LT patients to detect cabapenem‐resistant Enterobacteriacae infection after LT. ( 9 ) Although these tools may be a priori complicated, authors publishing in Liver Transplantation should be encouraged to follow them for a comprehensive score evaluation.…”