What is Model for End-Stage Liver Disease (MELD) ?
BDS (Bachelor of Dental Surgery), 6 years of experience
What is the meaning of the Model for End-Stage Liver Disease (MELD)?
Model for End-Stage Liver Disease (MELD). MELD and Child-Pugh scores serve to measure the severity of a person’s liver disease. MELD score helps assess the severity of liver disease for predicting survival of the patient and estimating the risks and benefits of specific treatments. It helps in the process of organ allocation for liver transplantation and guiding the goals of care.
In today’s article, we will tell you in detail about the model for end-stage liver disease (MELD).
- What is MELD score?
- When does one need a MELD score?
- How is the MELD score calculated?
- How often is MELD score updated?
- What factors other than MELD score affect the waiting time for liver transplant?
- What are “exception points” in MELD score?
- What is Child-Pugh score?
- How is the Child-Pugh score calculated?
What is MELD score?
Model for End-Stage Liver disease or MELD is a scoring system which is used to assess the severity of chronic liver disease and prioritize the recipient for liver transplant surgery. The MELD score estimates the risk of death within 90 days without a liver transplant surgery.
Based on various laboratory tests, the MELD score is calculated which can range from 6-40. A higher MELD score indicates the urgent need for a liver transplant. Also, a higher MELD score also indicates a higher position on the transplant waiting list. Doctors use a similar scoring system known as Pediatric End-Stage Liver Disease (PELD) score for children younger than 12 years of age.
When does one need a MELD score?
Here are some conditions that lead to liver failure where the patient might need a liver transplant. In such cases, a MELD score is needed.
- Liver Cirrhosis– This is a condition where healthy liver cells are replaced by fibrotic scar tissue. Liver cirrhosis is a slow and gradual process. ( Know more about- What is Liver Cirrhosis? )
- Hepatitis– This is an infection of the liver caused by hepatotropic viruses. ( Know more about- What is Hepatitis B ? )
- Alcoholic liver disease– This is a condition where chronic use of alcohol causes damage to the liver cells that results in scarring of the liver tissues.
- Hemochromatosis– This is a condition in which the body stores excess iron.
- Wilson’s disease– This is a disease where an excess of copper is stored in the liver and various other organs. ( Know more about- What is Wilson’s disease? )
- Primary biliary cirrhosis– This is a diseased condition caused due to gradual, progressive damage of the small bile ducts of the liver. This leads to accumulation of bile and other toxins in the liver.
- Primary sclerosing cholangitis– This is a disease of the liver and gallbladder, characterized by inflammation and scarring of the bile ducts.
- Biliary atresia– This is a genetic condition where there is blockage of bile ducts that carry bile from liver to the gallbladder. This condition has symptoms like jaundice, dark urine, swollen stomach, etc.
If your doctor suggests that you need a liver transplant surgery, your MELD score is one of several things that indicate your place on the waiting list for the liver transplant.
How is the MELD score calculated?
The MELD score is calculated based on the results of a person’s multiple lab tests, which include-
- Creatinine level– This test shows how well a person’s kidneys are functioning.
- Bilirubin level– This test shows how well a person’s liver is able to remove bile from the body. ( Know more about- What is Liver function tests? )
- INR (international normalized ratio)- This test shows how well your liver makes the factors needed for blood clotting.
- Serum sodium level– This test indicates the concentration of sodium in the person’s blood.
How often is MELD score updated?
The MELD score is not constant and changes as the patient’s condition changes. Patient’s medical condition, previous treatments done and the last MELD score determines how often the MELD score needs to be updated.
If the patient’s condition worsens, the MELD score becomes higher. Also depending on how critical the disease is, the MELD score can be recalculated as often as once a week.
Here is a list of the typical MELD scores and how often they are updated and recalculated–
- Less than 10 – It will be recalculated once a year.
- 11 to 18 – It will be recalculated every 3 months.
- 19 to 24 – It will be recalculated once a month.
- 25 or more – It will be calculated every week.
Kindly refer to your doctor/ liver disease specialist for more information about MELD scores.
What factors other than MELD score affect the waiting time for liver transplant?
The MELD Score alone doesn’t predict the waiting time on the liver transplant list. There are certain factors that affect how fast one is offered liver for transplant surgery. These include-
- The supply and demand of livers in the area
- Geographically, how close one is to the donated liver
- Blood group
- Size of the body
- Age of the donor
If the transplant center believes that a person’s MELD score does not accurately show how quickly a person needs a liver transplant, the transplant center will add few “exception points” to the patient’s MELD score. The transplant center submits the paperwork to the Regional Review Board in order to do this. ( Know more about- What is Liver Transplant Surgery ? )
What are “exception points” in MELD score?
Exception points are the health conditions that may be added to the patient’s MELD score. These are added to the patient’s MELD score when the doctor or the transplant center believes that MELD score alone doesn’t explain the urgency of liver transplant. These include-
- Cholangiocarcinoma– This is the cancer of the bile ducts that carry the digestive fluid bile.
- Cystic Fibrosis– It is a genetic disease that causes damage to the digestive system and lungs.
- Familial amyloid polyneuropathy (FAP)– This is a rare, inherited, progressive disease causing damage to nerves and other tissues of the body.
- Hepatic artery thrombosis (HAT)– In this condition , the blood clots in the artery that supplies blood to the liver.
- Hepatocellular Carcinoma (HCC)- This is the most common cancer of the liver. People at higher risk of HCC may include the ones with Hepatitis B or C infection, liver cirrhosis, chronic alcohol users, etc.
- Hepatopulmonary syndrome (HPS)– This is a rare disorder where the lungs of people with advanced liver disease are affected.
- Porto-pulmonary hypertension– In this condition pulmonary hypertension is associated with portal hypertension.
- Primary hyperoxaluria– This is a rare genetic disorder associated with accumulation of a substance known as oxalate in the kidneys and other organs of the body.
The transplant center will update information about the patient’s exception points every three months.
In a crisis, one may get a special priority status. This happens when your doctor believes you may only have hours or days left to live before you need a liver transplant.
What is Child-Pugh score?
The Child-Pugh score, also known as the Child-Turcott-Pugh score, is used to assess the severity and also the prognosis in patients with chronic liver disease. It provides an idea about the severity of liver disease, the survival rate of the patient and how adequate the liver disease treatment should be.
How is the Child-Pugh score calculated?
The Child-Pugh score is calculated using the following five measures of the liver disease-
- Total bilirubin– This is a yellow-colored compound found in bile and blood when hemoglobin breaks down.
- Albumin– This is the main protein in the blood plasma that the liver makes.
- Prothrombin time or INR– This indicates time taken by the blood to clot.
- Ascites-In this condition, accumulation of fluid occurs in the abdominal cavity.
- Encephalopathy– This indicates whether the brain is affected by liver disease.
We hope that we could answer your questions regarding the Model for End-Stage Liver Disease (MELD) through this article.
If you want more information about the Model for End-stage Liver Disease (MELD), you can contact a Hepatologist
We only aim to provide you with information through this article. We do not recommend any medicine or treatment to anyone. Only a doctor/ liver disease specialist can give you good advice.
