Format

Send to

Choose Destination
Curr Opin Gastroenterol. 2010 May;26(3):209-13. doi: 10.1097/MOG.0b013e32833867d8.

Organ allocation for chronic liver disease: model for end-stage liver disease and beyond.

Author information

1
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Abstract

PURPOSE OF REVIEW:

Implementation of the model for end-stage liver disease (MELD) score has led to a reduction in waiting list registration and waitlist mortality. Prognostic models have been proposed to either refine or improve the current MELD-based liver allocation.

RECENT FINDINGS:

The model for end-stage liver disease - sodium (MELDNa) incorporates serum sodium and has been shown to improve the predictive accuracy of the MELD score. However, laboratory variation and manipulation of serum sodium is a concern. Organ allocation in the United Kingdom is now based on a model that includes serum sodium. An updated MELD score is associated with a lower relative weight for serum creatinine coefficient and a higher relative weight for bilirubin coefficient, although the contribution of reweighting coefficients as compared with addition of variables is unclear. The D-MELD, the arithmetic product of donor age and preoperative MELD, proposes donor-recipient matching; however, inappropriate transplantation of high-risk donors is a concern. Finally, the net benefit model ranks patients according to the net survival benefit that they would derive from the transplant. However, complex statistical models are required and unmeasured characteristics may unduly affect the model.

SUMMARY:

Despite their limitations, efforts to improve the current MELD-based organ allocation are encouraging.

PMID:
20224394
PMCID:
PMC2919807
DOI:
10.1097/MOG.0b013e32833867d8
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center