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Cited by 174Liver Disease and TransplantationOrgan Transplantation Techniques and OutcomesLiver Disease Diagnosis and Treatment

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The MELD score in patients awaiting liver transplant: Strengths and weaknesses

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Bernardi, Mauro, Gitto, Stefano, Biselli, Maurizio·2011·Journal of Hepatology
DOI 10.1016/j.jhep.2010.11.008
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Abstract

Adoption of the Model for End-stage Liver Disease (MELD) to select and prioritize patients for liver transplantation represented a turning point in organ allocation. Prioritization of transplant recipients switched from time accrued on the waiting list to the principle of "sickest first". The MELD score incorporates three simple laboratory parameters (serum creatinine and bilirubin, and INR for prothrombin time) and stratifies patients according to their disease severity in an objective and continuous ranking scale. Concordance statistics have demonstrated its high accuracy in stratifying patients according to their risk of dying in the short-term (three months). Further validations of MELD as a predictor of survival at various temporal end-points have been obtained in independent patient cohorts with a broad spectrum of chronic liver disease. The MELD-based liver graft allocation policy has led to a reduction in waitlist new registrations and mortality, shorter waiting times, and an increase in transplants, without altering overall graft and patient survival rates after transplantation. MELD limitations are related either to the inter-laboratory variability of the parameters included in the score, or to the inability of the formula to predict mortality accurately in specific settings. For some conditions, such as hepatocellular carcinoma, widely accepted MELD corrections have been devised. For others, such as persistent ascites and hyponatremia, attempts to improve MELD's predicting power are currently underway, but await definite validation.

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  • The field has recognised that the MELD score is not the most optimal endpoint for evaluating therapeutic efficacy in trials targeting fibrosis progression and resolution.

    “Since the trial was designed and initiated, the field has recognised that the MELD score is not the most optimal endpoint for evaluating therapeutic efficacy in trials targeting fibrosis progression and resolution (177, 178)”

    From Targeting macrophages in liver fibrosis (2026) · cites this paper as [178]

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Metadata

Authors
Bernardi, M., Gitto, S., & Biselli, M.
Affiliations
University of Bologna (IT)
Corresponding author
Bernardi, Mauro
ORCID
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2011-06
Volume
54
Issue
6
Pages
1297-1306
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2010.11.008
OpenAlex
W2088136673
Cited by
174
References
3
Citations by year
2026: 7 · 2025: 6 · 2024: 11 · 2023: 18 · 2022: 20 · 2021: 13 · 2020: 11 · 2019: 13 · 2018: 12 · 2017: 11 · 2016: 9 · 2015: 9 · 2014: 6 · 2013: 14 · 2012: 10
FWCI
5.88
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hepatology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
  • Florence Research (University of Florence) (submittedVersion)
  • INFM-OAR (INFN Catania) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
Keywords
MELD score, liver transplantation, organ allocation, mortality prediction, disease severity classification, serum creatinine, bilirubin, prothrombin time, chronic liver disease, hepatocellular carcinoma, waitlist mortality, ascites, hyponatremia
MeSH terms
Carcinoma, Hepatocellular, Humans, Hypertension, Portal, Hyponatremia, Liver Neoplasms, Models, Biological, Tissue and Organ Procurement, Predictive Value of Tests, Prognosis, Severity of Illness Index, Waiting Lists, Liver Transplantation, Malnutrition, End Stage Liver Disease

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