Impact of Meld Sodium on Liver Transplantation Waiting List

Abstract

Background: Serum sodium was incorporated to MELD score for the allocation of liver transplantation In the USA in 2016. Hyponatremia significantly increased the efficacy of the score to predict mortality on the waiting list. Such modification was not adopted in Brazil. Aim: To carry out a simulation using MELD-Na as waiting list ordering criteria in the state of Paraná and to compare to the list ordered according to MELD score. Methods: The study used data of 122 patients waiting for hepatic transplantation and listed at Parana´s Transplantation Central. Two classificatory lists were set up, one with MELD, the current qualifying criteria, and another with MELD-Na. We analyzed the changes on classification comparing these two lists. Results: Among all patients, 95.1% of the participants changed position, 30.3% showed improvement, 64.8% presented worsening and 4.9% maintained their position. There were 19 patients with hyponatremia, of whom 94.7% presented a change of position, and in all of them there was an improvement of position. One hundred and one patients presented sodium within the normal range and 95% of them presented a change of position: Improved placement was observed in 18.8%, and worsened placement in 76.2%. Two patients presented hypernatremia and changed their position, both worsening the placement. There was a significant different behavior on waiting list according to sodium serum level when MELD-Na was applied. Conclusion: The inclusion of serum sodium caused a great impact in the classification, bringing benefit to patients with hyponatremia.

MRI Estimation of Liver Function: Comparison Between Normals and Cirrhotic Patients with Different MELD-Na Scores

“…doi: 10.7243/2054-1945-9-1 MELD-Na scoring system has been successfully used to classify the severity of cirrhosis and is a decision-making tool for the management of cirrhotic patients including liver transplantation [11][12][13]. The MR estimated liver function based on T1 ratio was significantly different between the different severity of MELD-Na groups.…”

Risk Factors Associated With Hepatic Artery Thrombosis: Analysis of 1050 Liver Transplants

“…It uses serum values of total bilirubin, creatinine and INR (International Normalized Ratio). MELD sodium is a modified score that adds the value of natremia in the calculation of the prediction of mortality 10 . The Child-Turcotte-Pugh classification was created to, through the evaluation of clinical and laboratory elements, establish a score that evaluates the primary liver functions 16 .…”

Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia

“…This formula increases the MELD score for patients with serum sodium <137 mEq/dL; however, patients with sodium <125 mEq/dL do not get any additional MELD increase. 162 MELD exceptions. The MELD system is based on equity and the idea that LT should be performed faster for the sickest patients with high short-term mortality.…”