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Semin Liver Dis
DOI: 10.1055/a-2464-9543
Review Article

Advancements in MELD Score and Its Impact on Hepatology

David Hudson
1   Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
,
Francisco Javier Valentin Cortez 
2   Obesity and Digestive Diseases Unit, Medica Sur Hospital, Mexico City, Mexico
,
Ivonne Hurtado Díaz de León 
3   Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
,
Gurpreet Malhi
1   Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
,
Angelica Rivas
4   Department of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Tamoor Afzaal
1   Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
,
Mahsa Rahmany Rad
1   Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
,
Luis Antonio Diaz 
5   Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
6   Division of Gastroenterology and Hepatology, MASLD Research Center, University of California San Diego, San Diego, California
,
Mohammad Qasim Khan
1   Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
7   Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
,
Juan Pablo Arab 
5   Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
8   Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Abstract

There continues to be an ongoing need for fair and equitable organ allocation. The Model for End-Stage Liver Disease (MELD) score has evolved as a calculated framework to evaluate and allocate patients for liver transplantation objectively. The original MELD score has undergone multiple modifications as it is continuously scrutinized for its accuracy in objectively representing the clinical context of patients with liver disease. Several refinements and iterations of the score have been developed, including the widely accepted MELD-Na score. In addition, the most recent updated iteration, MELD 3.0, has been created. The MELD 3.0 calculator incorporates new variables such as patient sex and serum albumin levels and assigns new weights for serum sodium, bilirubin, international normalized ratio, and creatinine levels. It is anticipated that the use of MELD 3.0 scores will reduce overall waitlist mortality and enhance access for female liver transplant candidates. However, despite the emergence of the MELD score as one of the most objective measures for fair organ allocation, various countries and healthcare systems employ alternative methods for stratification and organ allocation. This review article will highlight the origins of the MELD score, its iterations, the current MELD 3.0, and future directions for managing liver transplantation organ allocation.

Lay Summary

Organ donation is crucial for the management of patients unwell with liver disease, but organs must be allocated fairly and equitably. One method used for this is the Model for End-Stage Liver Disease (MELD) score, which helps objectively decide which patient is a candidate for liver transplant. Over time, the MELD score has been refined to better reflect patients' needs. For example, the latest version, MELD 3.0, now considers factors like nutrition and gender. This should ensure that more patients, especially females, are candidates and receive appropriate access to liver transplantation. However, not every country uses the MELD score. Some countries have created their own scoring systems based on local research. This review will explain where the MELD score came from, how it has changed, the current characteristics of the MELD 3.0 score, and what the future might hold for organ allocation in liver transplants.

Keywords

cirrhosis - liver disease - model for end-stage liver disease - hepatology - risk stratification - organ allocation

Authors' Contribution

Authors confirm their contribution to the article as follows:


D.H.: investigation, writing—original draft, writing—review and editing. G.M., A.R., T.A., F.J.V.C., I.H.D.d.L., M.R.R.: writing—original draft, writing—review and editing. L.A.D., M.Q.K.: writing—review, editing, and supervision. J.P.A.: conceptualization, writing—review, editing, and supervision.




Publication History

Accepted Manuscript online:
08 November 2024

Article published online:
11 December 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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