How to Understand a MELD Score

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Surgical transplant can save the life of a person with end-stage liver disease.
Surgical transplant can save the life of a person with end-stage liver disease. (Image: laparoscopic surgery image by Grzegorz Kwolek from Fotolia.com)

End-stage liver disease in adults can be caused by cirrhosis, hepatitis, cancer or autoimmune processes. Children can develop severe damage to liver function congenitally or through infection or injury. Each year since 2006, the waiting list for liver transplant has exceeded 100,000 people, according to the U.S. Department of Health and Human Services. In the 12 years between January 1, 1988, and May 31, 2010, there were 98,737 transplants using livers from deceased donors and 4,104 from living donors.

The Model for End-stage Liver Disease (MELD) was developed to prioritize transplant candidates by determining their chances of survival.

Gather your latest lab values. The MELD score is based on your bilibubin, which measures how well your liver processes and removes bile; your INR, or International Normalized Ratio, a test of your liver's ability to make blood-clotting factors; and your creatinine level, an evaluation of your kidney function. In 2006 the sodium level, abbreviated Na, was added in order to assess the ability of the body to manage fluid and electrolyte levels. A team from the Mayo Clinic, writing in the May 2006, issue of "Gastroenterology" found that adding the sodium (Na) level to the MELD scoring system provides a more reliable prediction of survival. The MELD-Na is used for determining eligibility for transplant when sodium level is between 120 and 135 mEq/L (milli-equivalent per liter). A decrease in serum sodium of 1 mEq/L corresponds to a 12 percent decreased chance of a three-month survival for a person with end-stage liver disease, according to French researchers François Durand, M.D., and Dominique Valla, M.D.

Enter the lab values into a MELD-Na calculator, such as the one provided by the Mayo Clinic. The result will be a MELD-Na score. A score of less than 10 is considered a low priority for transplant and tests need to be repeated annually. Between 11 and 18 the tests are done at least every 90 days and the physicians will begin discussing the option of transplant. Most transplants take place at a MELD near 20. Test scoring between 19 and 24 require that the labs be repeated every 30 days. When the MELD is above 25, test results must be entered every week, as the patient's condition can change rapidly. Some centers do transplants for higher MELD scores but on average the stated upper limit is between 26 and 33.

Look around your family and friends for a potential living donor. This is especially important if your MELD score is too high to warrant allocating a cadaver liver to you or too low to place you high on the transplant list. In 2002, a New York State Committee on Quality Improvement issued a statement prohibiting living donor transplant for people with MELD scores over 25. But in the January 2010, edition of the "Annals of Surgery," researchers from the University of Toronto determined that living donor liver recipients with MELD scores above and below 25 had similar one-, three- and five-year survival statistics. Many factors determine eligibility for living donor transplant but the authors of this study suggest it be used to eliminate one significant roadblock.

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