MELD and PELD: Application of survival models to liver allocation

Model for End-stage Liver Disease

“…This allowed wider acceptability of the score keeping the same abbreviation of MELD. 7,8 Other changes made to the score by the UNOS were: capping serum creatinine at 4 mg/dl, capping the score at 40, and setting the lower limit for each component of the score to 1 in order to avoid negative scores. Further, etiology of the liver disease as a factor was removed from the model, as this did not impact mortality amongst patients with end-stage liver disease awaiting LT. 5 …”

Simultaneous Liver–Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

“…Six weeks was chosen because after 4 weeks of dialysis, the rate of renal recovery declines significantly (17). Moreover, recipients of SLK transplant have higher MELD scores (2), and the survival of these patients for >6 weeks is anticipated to be very low (18). In addition, for those patients not requiring dialysis and not having a prior diagnosis of CKD, an eGFR of <25 mL/min for six or more consecutive weeks was added to the definition of sustained acute kidney injury.…”

Air transportation of patients with end-stage liver disease to distant liver transplantation centers

“…1). The average distance traveled was 4660 miles (range, 1290-7400), average flight time was 9.5 hours (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], the mean number of takeoffs and landings/travel was 3.6 (range, 2-6). Medical staff escorted 22 patients.…”

“…In contrast, most chronic patients were well enough to travel on their own, accompanied either by a nurse or a competent family member without medical escort, whereas some were considered critically ill requiring a medical escort. For patients with chronic liver disease the average MELD score was 19.94 (range, 3-41) and the CPT score was 9.9 (range, [5][6][7][8][9][10][11][12][13][14]. Two patients were flown by air ambulance (both were patients with fulminant hepatitis who traveled to Belgium), and the rest (n ϭ 41) by designated commercial flights when patients could be placed on a stretcher (usually at the rear of the plane), or in a comfortable seat.…”

“…The severity of chronic liver disease was assessed by the MELD score. 9 The ChildTurcotte-Pugh (CTP) score was also assessed using the established methods. 10 For patients with FHF the King's College criteria 11 were assessed.…”