Re-weighting the Model for End-Stage Liver Disease Score Components

Model for End-stage Liver Disease

“…Updated MELD (assigning lower weight to creatinine and INR while higher weight to bilirubin based on SRTR analysis of 38,899 patients transplanted between 2001-2006), 130 refit MELD (reassigning lower and upper limits of 0.8 and 3.0 for serum creatinine while 1 and 3 for INR respectively), 128 integrated MELD including sodium and age, 93 MESO (ratio of MELD to serum sodium), MeldNa (incorporating serum sodium for levels between 125 and 140 mmol/L), 124 UK end stage liver disease score (UKELD) which is similar to MELD-Na and is used for listing patients for liver transplantation in the UK, 131 and ReFit MELD-Na as for refit MELD but including serum sodium also 128 are some of the refinements, which have been tried to improve the accuracy of the MELD score. In one study, comparing these models, UKELD and updated MELD were poor in predicting mortality compared to other 4 models.…”

Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation

“…Clinicians are often challenged when they are determining the cost/efficiency of liver transplantation for very frail and deconditioned patients with cirrhosis, and in order to avoid futile liver transplants, some validated but subjective measures of post-liver transplant survival, such as admission to the intensive care unit, the use of mechanical ventilation or renal replacement therapy, multiorgan failure, advanced age, and hepatitis C virus (HCV) infection and comorbidities, are being used to screen patients who may present with poor outcomes after transplantation. [7][8][9] Currently, cross-sectional imaging studies such as computed tomography (CT) scans are the gold standard for quantifying skeletal muscle mass 10 and hence constitute good resources for objective and detailed nutritional/metabolic assessments of patients and for the identification of sarcopenia. Moreover, the measurement of a single abdominal image of the third lumbar vertebra (L3) provides an excellent estimation of the total body skeletal muscle.…”

The Impact of Donor Type and Quality on Renal Transplant Outcomes

“…Unlike the ANZDATA study, there was no net benefit of implementing an old-forold allocation system with regards to overall functional graft years (Table 4). (Sharma, Schaubel et al 2008). In addition, based on DPI, the kidneys with the longest survival potential will be allocated according to the combined score of LYFT (80% of total score) and dialysis time/PRA (20% of total score), whereas kidneys with lesser potential for long-term survival will be allocated according to dialysis time and PRA, such that better donor kidneys are allocated to younger potential recipients, who will have the longest expected LYFT.…”