The Use of Meld Score (Model for End-Stage Liver Disease) and Derivatives in Cardiac Transplantation

Abstract

Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors “heart transplantation”, “liver disease” and “prognosis”. From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.

Relationship between right atrial pressure and the Model for End-Stage Liver Disease (MELD) score in patients with advanced heart failure

“…They argued that a high MELD-XI score was an independent predictor of cardiac death and all-cause death in patients with HF. In addition, Moraes[ 11 ] suggested that the use of MELD could contribute to the evaluation of the severity of HF in patients who are candidates for transplantation. This could help in setting up a system, similar to liver transplantation, of priority-based transplants for patients requiring a transplant at the earliest.…”

“…This could help in setting up a system, similar to liver transplantation, of priority-based transplants for patients requiring a transplant at the earliest. [ 11 ]…”

The Predictive Role of MELD-Albumin Score in ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…Ayrıca, antikoagülan kullanımı nedeniyle hesaplama sırasında INR'yi hariç tutan modifiye MELD skoru olan MELD-XI'nun çeşitli kardiyavasküler girişim sonuçlarını tahmin etmede yararlı olduğu doğrulanmıştır (10,11). Ek olarak, INR yerine albümin serum değerini içeren MELD-Albumin skorunun kalp nakli ve çeşitli kalp kapağı girişimi sonrası klinik sonuçlarla ilişkili olduğu gösterilmiştir (12,13). Bununla birlikte, primer perkütan koroner girişim (pPKG) uygulanan STEMI hastalarında bu 2 modifiye MELD skoru daha önce çalışılmamıştır.…”

Impact of Meld Sodium on Liver Transplantation Waiting List

“…This is a mathematical model that estimates the mortality risk of a patient with terminal liver disease based on the following laboratory tests: total bilirubin, creatinine and INR 13 . This model was previously developed to predict the survival of cirrhosis patients subjected to transjugular intrahepatic portasystemic shunt (TIPS), since some studies have proven that it could be used as a reliable tool to evaluate survival in patients with chronic liver disease 10 , 14 . In general, MELD presents two important advantages in the search for better hepatic allocation.…”