However, the model for end-stage liver disease (MELD) score has brought us close to this goal. The answer to the question: “Do we possess such an ideal tool?” is, unfortunately, “No”. Hence, an ideal tool should be able to: (a) quantify the patient’s chances of survival in the short to medium-term for optimum prioritization of patients awaiting OLT (b) classify patients according to their disease stage, enabling doctors to establish whether it is too early, appropriate, or too late to suggest OLT (c) predict outcome irrespective of the underlying liver disease (d) be readily manageable, possibly at the bedside (e) last, but not least for most experts, set aside subjective elements influencing the doctors’ judgment, such as features of the transplant center in terms of organization and technical and human resources, the physician’s individual expertise, which could be based on personal belief rather than evidence-based data, and both personal and environmental emotional pressure. Thus, liver allocation policy should assign grafts to patients most in need. Sub-optimal utilization of liver grafts in a time of scarcity would further exacerbate the harm as the transplanted patient would not benefit from having received an organ that was not offered to another possibly more suitable candidate, who may well die as a result. Too early an operation could reduce the chances of survival, whereas too late a transplant would be associated with an unbearable peri-operative and short-term mortality. KeywordsĪbbreviations: OLT ( orthotopic liver transplantation), MELD ( model for end-stage liver disease), UNOS ( United Network for Organ Sharing), CTP ( Child-Turcotte-Pugh), INR ( international normalized ratio), HCC ( hepatocellular carcinoma), GFR ( glomerular filtration rate), MDRD ( Modification of Diet in Renal Disease), MELD-Na ( MELD and serum sodium), iMELD ( integrated MELD), UKELD ( United Kingdom MELD), MESO ( MELD to serum sodium ratio), PT ( prothrombin time) For others, such as persistent ascites and hyponatremia, attempts to improve MELD’s predicting power are currently underway, but await definite validation. For some conditions, such as hepatocellular carcinoma, widely accepted MELD corrections have been devised. 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.
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