The Evolution of the MELD Score and Its Implications in Liver Transplant Allocation: A Beginner's Guide for Trainees

Introduction: The burden of chronic liver disease (CLD) is increasing globally and the ultimate treatment is a liver transplant. As Pakistan is a developing country, liver transplantation is not easily available due to limited resources. This study aims to assess the patients with CLD for liver transplantation and to find the frequency of eligible candidates for liver transplantation.Methods: A cross-sectional observational study was conducted on patients with CLD from June 2022 to December 2022. Total bilirubin, serum creatinine complete blood count, serum electrolytes, and international normalised ratio (INR) were done. The Model for End-Stage Liver Disease (MELD) score was calculated and the frequency of eligible patients for liver transplant was determined. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY, USA).Results: In our study, 149 patients were enrolled with a mean age of 46.81±15.7 years. There were 58.7% male and 41.6% female patients. The mean duration of liver cirrhosis was 18.22±11.7 months. The mean MELD score was 20.71±5.2. The common liver cirrhosis stages were stage II and stage II was found in 32.2% of each. Hepatocellular carcinoma (HCC) was present in 15.4% of patients. There were 25.5% of patients eligible for liver transplants. Conclusion:In our study, we found that significant numbers of patients with CLD were eligible for liver transplantation.

Section: Discussionmentioning

confidence: 99%

Assessment of Liver Transplant Eligibility in Chronic Liver Disease Patients: A Cross-Sectional Study From a Tertiary Care Hospital of Pakistan

Hassan,

Khan,

Khan

et al. 2024

“…For patients whose clinical status transitions from decompensation into end-stage disease, the MELD-Na is a scoring system used to evaluate potential candidates for liver transplantation but has other applications, including predicting mortality in fulminant hepatic failure, alcoholic hepatitis, cirrhosis with infections, variceal bleeding, trauma, and hepatorenal syndrome, among other complications [ 10 ]. The components of the MELD-Na score include serum bilirubin, serum creatinine, international normalized ratio, and serum sodium [ 10 , 11 ]. MELD-Na scores range from six to 40 and higher scores correlate with increased disease severity and priority for organ allocation [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Cirrhosis, Hepatitis B Superimposed Infection, and the Emergence of an Acute Portal Vein Thrombosis: A Case Report

Kasmikha¹,

Khan²,

Almajed³

et al. 2023

Acute portal vein thrombosis (PVT) is a complication of liver cirrhosis. The presence of viral infections such as hepatitis B (HBV) and hepatitis C (HCV) can further increase cirrhotic patients’ risk of developing PVT, especially in the rare case when there is superinfection with both HBV and HCV. We present a patient with HCV cirrhosis whose clinical condition was decompensated secondary to the development of superimposed HBV infection, who developed acute PVT during hospitalization. This case offers a unique presentation of acute PVT that developed within several days of hospitalization for decompensated liver disease, as proven by the interval absence of portal venous flow on repeat imaging. Despite the workup on the initial presentation being negative for PVT, reconsideration of differentials after the change in our patient’s clinical status led to the diagnosis. Active HBV infection was likely the initial trigger for the patient’s cirrhosis decompensation and presentation; the subsequent coagulopathy and alteration in the portal blood flow triggered the development of an acute PVT. The risk for both prothrombotic and antithrombotic complications remains high in patients with cirrhosis, a risk that is vastly increased by the presence of superimposedinfections. The diagnosis of thrombotic complications such as PVT can be challenging, thus stressing the importance of repeat imaging in instances where clinical suspicion remains high despite negative imaging. Anticoagulation should be considered for cirrhotic patients with PVT on an individual basis for both prevention and treatment. Prompt diagnosis, early intervention, and close monitoring of patients with PVT are crucial for improving clinical outcomes. The goal of this report is to illustrate diagnostic challenges that accompany the diagnosis of acute PVT in cirrhosis, as well as discuss therapeutic options for optimal management of this condition.

“…It estimates the likelihood of a patient surviving their disease over the next three months [ 19 ]. Similarly computed using serum bilirubin, serum creatinine, and INR, the MELD score ranges from six to 40, with higher scores indicating more severe liver disease [ 18 , 20 ]. Patients with higher MELD scores are given higher priority on the transplant waitlist for a deceased donor organ [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

“…This implementation has led to a reduction of 3.5% in waiting list mortality, a 10.2% increase in deceased donor transplants, and a 12% decrease in patients awaiting transplantation [ 22 ]. Notably, patients with lower MELD scores should still be considered for liver transplantation, as significant living-donor liver transplants can serve as life-saving options for this subset of patients who may otherwise not qualify for transplantation [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

Navigating Cirrhosis: A Comprehensive Review of Liver Scoring Systems for Diagnosis and Prognosis

Kotak,

Kumar,

Kumar

et al. 2024

This comprehensive review navigates the landscape of liver scoring systems for the diagnosis and prognosis of cirrhosis. Cirrhosis, a chronic and progressive liver disease, presents significant challenges in its diagnosis and management. The review begins by defining and providing an overview of cirrhosis, emphasizing its clinical implications. Highlighting the significance of liver scoring systems, including the Child-Pugh score, end-stage liver disease, albumin-bilirubin (ALBI) score, and fibrosis-4 (FIB-4) index, the study explores their role in assessing liver dysfunction severity and predicting outcomes. A meticulous analysis identifies the strengths and limitations of these scoring systems, offering valuable insights for clinicians. The recommendations emphasize incorporating these tools into routine clinical practice for early intervention and personalized treatment plans. Interdisciplinary collaboration is underscored as crucial for a holistic approach to cirrhosis management. The conclusion calls for future research to refine existing scoring systems, explore emerging biomarkers and imaging techniques, and conduct prospective studies to enhance precision. By embracing these recommendations, the medical community can advance the understanding and management of cirrhosis, ultimately improving patient outcomes and revolutionizing liver disease approaches.