MELD fails to measure quality of life in liver transplant candidates

Abstract

L iver allocation is currently based on the model for end-stage liver disease score (MELD). 1 The transition from using Child-Turcotte-Pugh (CTP) class to the MELD score in liver transplantation was based on studies demonstrating that the MELD score better predicted short survival than did the United Network for Organ Sharing (UNOS) status, which was based on CTP score. 2,3,4 In a recent study of 3437 adults added to the liver transplantation waiting list, the MELD score was found to be a better predictor of short-term survival than CTP scores. 5 The MELD score uses three laboratory parameters-International Normalized Ratio (INR), serum creatinine, and serum bilirubin, 2,3 -to predict shortterm prognoses and thus is believed to be an accurate measure of liver disease severity. Complications such as hepatic encephalopathy and ascites, which are inherent in the CTP score, are not included in the MELD score. 6 These manifestations of decompensated liver disease are subjective and lack strict operational definition, rendering them amenable to diverse interpretation. Moreover, these manifestations have not shown to increase the predictive ability of the MELD score substantially. 4 While previous studies have demonstrated that liver disease severity as assessed by the CTP score is associated with impaired quality of life, 7,8,9,10,11 it is not clear whether the MELD score is also associated with quality of life. Both hepatic encephalopathy and ascites, which can affect quality of life, are not part of the MELD score. Furthermore, the MELD score has not been correlated with the severity of ascites and hepatic encephalopathy. 12 Thus, liver disease severity assessed by the Abbreviations: MELD, model for end-stage liver disease; CTP,

Branched-chain amino acid supplements reduced ascites and increased the quality of life in a patient with liver cirrhosis: A case report

“…First, marked retention of ascites was noted on admission. in general, the presence of ascites is significantly associated with a poor QOL in cirrhotic patients (18). as a result of Bcaa-rich supplements, decreased ascites reduced abdominal tension.…”

Disease Targeted Measures of Health Related Quality of Life (HRQOL) in Patients with Advanced Liver Disease Before and After Liver Transplantation

“…Some authors, studying the association between HRQOL and survival in patients with cirrhosis, showed that the relation between HRQOL and survival was MELD (Model of EnStage Liver Disease) independent (Kanwal, 2004;Saab, 2005). Kanwal et al, found that higher baseline HRQOL predicted lower mortality (Kanwal, 2009).…”

“…CTP score may be a better proxy measure than MELD, due to being based on clinical data and is more patient centered disease in persons with decompensated chronic liver disease (Saab, 2005). Both hepatic encephalopathy and ascites, which can affect quality of life, are not part of the MELD score.…”

“…Thus, liver disease severity assessed by the MELD score may no longer correlate with quality of life. (Saab, 2005) (Table 5). …”

Funcionamiento biopsicosocial entre pacientes cirróticos en distin-tas etapas del proceso de trasplante y su comparación con trasplantados hepáticos.

“…However, in view of the fact that current liver transplantation research does not only focus on survival but also on quality of life, there is increasing scientific interest in analyzing the relationship between the MELD and quality-of-life dimensions. To date, the results about this relationship are controversial, ranging from an absence of correlation (Ortega et al, 2009;Saab et al, 2005) to negative correlations (Kanwal, Hays, Kilbourne, Dulai, & Gralnek, 2004;Rodrigue, Lisson, Wiak, Nelson, & Reed, 2006), or even positive correlations (the higher the MELD scores, the better quality of life), but only in cases of very severe hepatopathy (Castaldo, Feurer, Russell, & Pinson, 2009). …”