The model for end-stage liver disease (MELD).

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Hepatology. 2007 Mar;45(3):797-805.

The model for end-stage liver disease

(MELD).

Kamath PS, Kim WR; Advanced Liver Disease Study Group.

Advanced Liver Disease Study Group, Miles and Shirley

Fiterman Center

for Digestive Diseases, Mayo Clinic

College of Medicine, Rochester,

MN

The Model for End-stage Liver Disease (MELD) was

initially created to predict survival in patients with complications of portal

hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD

which uses only objective variables was validated subsequently as an accurate

predictor of survival among different populations of patients with advanced

liver disease. The major use of the MELD score has

been in allocation of organs for liver transplantation. However,

the MELD score has also been shown to predict survival in patients with

cirrhosis who have infections, variceal bleeding, as

well as in patients with fulminant hepatic failure

and alcoholic hepatitis. MELD may be used in selection

of patients for surgery other than liver transplantation and in determining

optimal treatment for patients with hepatocellular

carcinoma who are not candidates for liver transplantation. Despite

the many advantages of the MELD score, there are approximately 15%-20% of

patients whose survival cannot be accurately predicted by the MELD score. It is possible that the addition of variables that are

better determinants of liver and renal function may improve the predictive

accuracy of the model. Efforts at further refinement

and validation of the MELD score will continue.

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