The Model for End-Stage Liver Disease (MELD) score is now used for allocation in liver transplantation waiting lists, replacing the Child-Turcotte-Pugh score.
However, there is debate about its superiority in predicting mortality in patients with cirrhosis on the transplant waiting list and after liver transplantation.
Dr Andrew Burroughs and colleagues from England reviewed studies comparing the accuracy of both scores in transplantation settings.
The team identified 11 studies evaluating 12,532 patients on the liver transplantation waiting list.
Only 4 of the 11 studies showed MELD to be superior to Child-Turcotte-Pugh in predicting short-term mortality.
In addition, 2 of 3 studies evaluated the changes in MELD score.
|The predictive ability of MELD scores increase by adding clinical variables |
The team found that in these studies, MELD changes had better prediction for mortality than the baseline MELD score.
The researchers noted that the impact of MELD on post-liver transplantation mortality was assessed in 15 studies, with 20,456 patients.
Of these, 6 studies with 9522 patients evaluated the discriminative ability of MELD score using the concordance statistic.
In 11 studies with 19,311 patients, high MELD score indicated poor post-liver transplantation mortality for cutoff values of 24 to 40 points.
The team identified 4 studies including re-liver transplantation patients.
The researchers observed that only 2 of the 4 studies evaluated the discriminative ability of MELD score on post-liver transplantation mortality.
Dr Burroughs' team concluded, “Finally, several studies have shown that the predictive ability of MELD score increases by adding clinical variables or laboratory parameters.”
“On the basis of the current literature, the MELD score does not perform better than the Child-Turcotte-Pugh score for patients with cirrhosis on the waiting list, and cannot predict post-liver transplantation mortality.”