From the Guidelines
A MELD score of 30 or higher indicates that steroids may be futile and a liver transplant is urgently needed.
MELD Score and Liver Transplantation
- The Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for liver transplantation based on their disease severity 1.
- A MELD score of 15 or higher is recommended to list patients with end-stage liver disease for transplantation 1.
- However, for very sick patients, a MELD score of 30 or higher indicates a high risk of mortality and morbidity after transplantation, and alternative treatments such as steroids may be futile 1.
Limitations of MELD Score
- The MELD score has several limitations, including not providing a prediction of mortality following liver transplantation except for patients with very high MELD scores over 35 1.
- Other factors such as pulmonary complications of cirrhosis, hepatic encephalopathy, and primary hyperoxaluria may also require consideration for liver transplantation, regardless of MELD score 1.
Use of MELD Score in Clinical Practice
- The MELD score is widely used to allocate liver grafts in many countries, but the final decision for allocation is often based on multiple parameters, including the match with the donor and local priorities 1.
- In patients with acute liver failure, a MELD score of 30.5 or higher is recommended as a prognostic scoring system to predict the need for liver transplantation 1.
- In patients with autoimmune hepatitis, a MELD score of 30 or higher may indicate a poor prognosis and the need for alternative treatments such as liver transplantation, although the optimal timing is unknown 1.
From the Research
MELD Score and Liver Transplantation
- The Model for End-Stage Liver Disease (MELD) score is a reliable indicator of short-term survival in patients with end-stage liver disease 2, 3.
- The MELD score is used to prioritize deceased donor organ allocation for patients listed for liver transplantation in the United States 2, 4.
- A high MELD score indicates a higher priority for liver transplantation 5, 6.
MELD Score and Steroid Use
- Corticosteroids are effective in improving 30-day survival in patients with severe alcohol-associated hepatitis, but only in those with MELD scores between 21 and 51 6.
- The maximum effect of corticosteroid treatment is observed in patients with MELD scores between 25 and 39 6.
- No corticosteroid benefit is seen in patients with MELD scores higher than 51, suggesting that steroids may be futile in these cases and a liver transplant is urgently needed 6.