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MELD stands for Model End Stage Liver Disease (ESLD), a disease severity scoring system applied to adult liver patients. The pediatric version of the model is called PELD.
The MELD score replaces the Child-Turcotte-Pugh (CTP) score as a disease severity index. This change is designed to improve the organ allocation system in liver transplantion to ensure that available organs are directed to transplant candidates based on the severity of their liver disease rather than the length of time they have been on the waiting list. These efforts have been prompted by the socalled "final rule" issued in 1998 by the US Department of Health and Human Services. This rule states that organs should be allocated to appropriate transplant candidates based on medical urgency.
MELD score is calculated using a relatively simple formula that relies on three readily available objective variables:
- Serum creatinine (Scr; mg/dL)
- Total bilirubin (Tbil; mg/dL)
- INR (international normalized ratio)
The following rules must observed when using this formula:
- 1 is the minimum acceptable value for any of the three variables.
- The maximum acceptable value for serum creatinine is 4.
- The maximum value for the MELD score is 40.
The Formula & The Calculator:
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MELD Score = 10 {0.957 Ln(Scr) + 0.378 Ln(Tbil) + 1.12 Ln(INR) + 0.643}
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The Meld data must be recertified at certain intervals as indicated in the table below:
| Score | Recertify every | Lab Values |
| ³25 | 7 days | £48 hrs old |
| 24 - 19 | 30 days | £7 days old |
| 18 - 11 | 90 days | £14 days old |
| £10 | year | £30 days old |
| UNOS Listing Status
* |
| MELD Score | Listing Status | Comments |
| <24 | 3 | CPT score = 7 to 9; too early for transplantation |
| 24 - 29 | 2b | CPT score ≥10; end-stage chronic liver disease; severely ill pt, not requiring hospitalization |
| ≥30 | 2a | CPT score ≥10; end-stage chronic liver disease; severely ill pt, hospitalized in an ICU |
*Notes:
- Assuming pts meet listing criteria (appropriate cadidates for liver trasnplantation)
- Criteria for status 1
remain unchanges; acute liver failure/disease with estimated survival of <7 days (highest priority for liver transplantation).
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References |
- Yu AS, Ahmed A, Keeffe EB. Liver transplantation: evolving patient selection criteria.
Can J Gastroenterol. 2001;15(11):729-38.
- Wiesner RH et al. MELD and PELD: application of survival models to liver allocation.
Liver Transpl. 2001;7(7):567-80.
- Kamath PS et al. A model to predict survival in patients with end-stage liver disease.
Hepatology. 2001;33(2):464-70.
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