MELD Is a Success Yet Has Room to Improve

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Model

for End-Stage Liver Disease Is a Success Yet Has Room

to Improve

ALEXANDRIA,

VA -- March 1, 2007 -- A review of the studies on the Model for End-Stage Liver

Disease (MELD) found that it is an accurate predictor of survival of patients

with a variety of liver diseases, is particularly useful in allocating organs

for liver transplants, and can also be used to help determine the course of

treatment in certain cases. However, it is possible to

improve the accuracy of the model and efforts at refining will continue.

This review appears in the March 2007 issue of Hepatology, the official journal

of the American Association for the Study of Liver Diseases (AASLD).

MELD uses three widely available laboratory tests in a mathematical formula to

arrive at a score that predicts survival for patients with liver disease. It was initially created by researchers at the Mayo Clinic

in Rochester, MN

to predict survival following TIPS, a procedure to treat complications of liver

disease that involves the placement of a shunt, but its use has been expanded. Most notably, for the past five years, MELD has become the

standard for prioritizing patients awaiting liver transplants, replacing the

previous system where patients who were on the list for the longest period of

time received transplants first, regardless of how ill they were.

In the current review, S. Kamath, MD and W.

Ray Kim, MD of the Mayo Clinic who were

instrumental in creating and validating the model, reviewed how MELD is applied

and assessed its strengths and limitations. They found

that using MELD for organ allocation in liver transplants led to an immediate

reduction in the number of patients awaiting a liver transplant (12% decrease

in 2002) and also led to a reduction in mortality on the waiting list of almost

15%. However, MELD has not been shown to be useful in

predicting mortality following a liver transplant, probably because other

factors besides liver dysfunction play a role in transplant success. In addition, they found that use of healthcare resources

has not increased since the implementation of MELD because the sickest

patients, who were previously a drain on the healthcare system, are being

transplanted earlier.

MELD, along with the traditional Child Turcotte Pugh

(CTP) scoring system, predicts long-term survival in patients with late-stage

cirrhosis, but MELD has other applications as well. In

single center studies, it accurately predicts survival in patients with variceal (esophageal) bleeding and hepatitis B, and

predicts mortality in patients with alcoholic hepatitis and infections leading

to kidney failure. In addition, MELD can shed light on

outcomes for liver cancer treatments and different types of surgery other than

liver transplants.

Despite its accuracy, MELD has some limitations. For

patients awaiting liver transplants, it should be used only after reversible

complications, such as bacterial infections, have been treated. Also, the values used to determine the MELD score may be

variable depending on how they are measured. In order

to refine MELD, the authors conducted a study on how changing MELD scores

affect mortality. They found that the current MELD

score was the most important predictor of survivor, regardless of how it was

reached.

" In conclusion, based on its ability to rank patients with cirrhosis

according to their short term mortality, MELD has been recognized as a major

contributor to the daily practice of hepatology, "

the authors state. " Successful implementation of

MELD-based liver allocation in the U.S.

has been followed by widespread adoption of the system globally, attesting to

its validity. " It is also a useful tool in a wide

spectrum of disease severity and variety. However,

since it is by no means a perfect system, the authors conclude, efforts to

refine it must continue. SOURCE: AASLD

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

[Guest guest]

As I've discovered, however, the MELD score is actually biased against those of us with PSC. The three factors in the MELD model are: bilirubin, creatinine (actually a kidney function), and INR or prothrombin time. As PSC progresses, the bilirubin numbers deteriorate, so that's no problem for us. Where I have an issue is that I'm told that the creatinine and INR numbers won't be terrible until I'm nearly too sick and weak to survive transplant surgery. So, for me, and no doubt many PSC patients, the living donor route is the only real option. We may have terrible numbers of AST, alk phos, etc., but those won't be taken into account when deciding on organ allocation. Tom C , EA Consulting Group, Inc.2005 Loudoun County Service Business of the Year19440 Golf Vista Plaza

Ste 240Leesburg, VA 20176 cell faxThis written advice is not intended or written to be used, and it cannot be used by a taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer.

[Guest guest]

-----Original

Message-----

As I've discovered, however, the MELD score is actually biased

against those of us with PSC.

I don’t think

this is true at all. The old CTP

scoring system was biased, but not MELD.

In fact, people with PSC have better transplant outcomes than others.

Where I have an issue is that I'm told that the creatinine and INR

numbers won't be terrible until I'm nearly too sick and weak to survive

transplant surgery.

Please don’t believe

everything someone tells you. Check

out the research for yourself. Look

at all the people in our group who have had transplants. They weren’t “too sick and

weak to survive transplant surgery”. Doctor Von is back to work in just a few

months after his surgery. Doc

Aubrey, Tim R, Steve (who had 3 transplants!), Hillbilly Bob, Jim, , Darin,

, Terry, Phil, , , Mike, Todd, Peggy, and tons of others are doing well after their surgeries. Yes, some had a LDLT, but some didn’t. Look at Klug, he won an Olympic

medal after his transplant, he surely wasn’t too sick to survive! Hang in there and don’t let

yourself get too depressed or down.

Take care of yourself, exercise, eat right and stay as positive as

possible. We’re all together

in the fight, whatever it takes.

Barb in Texas (Son Ken, somewhere in top 5 at Baylor)

[Guest guest]

How true this seems to be. My husbands MELD score is around 18. He is currently in the hospital again due to problems with two of the 3 biliary tubes that he has. However as you say his numbers that determine the MELD score are good compared to the way he feels and the quality of life (or lack of) that he is experiencing. Though his overall condition is not seriously deteriorating his mental state is suffering dramatically. So much so that I was unable to leave him alone at the hospital this past Saturday night when he suffered a panic attack and his heart rate shot up to 170 and kept saying that he was seeing visions of his favourite dead dog calling him to come home to her. He wanted me to go home so that he could go be with her. Needless to say he was put on a heart monitor for the night and given atavan to hopefully calm him down. We are pursuing the live donor option and hopefully that will work out before my husband totally gives up. in PA husband Mark with PSC since 1994, UC since 1975.

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[Guest guest]

I was transplanted with a MELD of 31 due to exemption points for repeated cholangitis episodes. I worked full time up until the day I was called (it wasn't easy but I wasn't too sick to work and take care of my family.) I'm back to work full time again and feeling great. Talk to your center about possibility of exemption points.

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