Liver transplantation for the patient with high MELD

The model for end-stage liver disease (MELD) is a system for scoring the severity of liver disease. The model was developed in 2000 to predict survival in patients undergoing transjugular intrahepatic portosystemic shunt placement. However, in 2002, the Organ Procurement and Transplantation Network adopted the MELD score as the standard for prioritization of graft allocation for liver transplantation [1-3]. With few exceptions (hepatocellular carcinoma and acute liver failure), those patients with highest MELD scores have the highest priority for organ allocation for orthotopic liver transplantation (OLT) in many countries including the United States. Since the implementation of the MELD system, wait-list mortality has significantly decreased, waiting time to liver transplantation has been reduced by over 100 days, and the MELD score has proven to be a good marker for 1-year posttransplantation survival [4-7]. The MELD score is a composite of three laboratory values: the international normalized ratio (INR) [8], serum creatinine, and serum bilirubin [9].