From the Guidelines
Patients should be referred for liver transplantation when their MELD score reaches 15 or higher, as this is the threshold where the benefits of liver transplantation emerge and mortality risk increases significantly 1.
MELD Score Threshold
The MELD score is a critical predictor of short-term mortality risk in patients with decompensated cirrhosis, and a score of 15 or higher is typically considered the minimal listing threshold for transplantation 1.
- A MELD score of 15 or higher indicates a significant increase in mortality risk and is a strong predictor of the need for liver transplantation.
- The UKELD score, which incorporates serum bilirubin, creatinine, INR, and sodium, can also be used to predict survival benefit from transplantation, but the specific threshold for referral is less clearly defined in the provided evidence.
Referral Considerations
Early referral for liver transplantation is crucial, as the evaluation process can take several months, and patients with certain conditions may qualify for exception points that increase their priority on the waiting list 1.
- Patients with complications such as refractory ascites, recurrent variceal bleeding despite optimal management, hepatic encephalopathy, or hepatocellular carcinoma within transplant criteria should be referred regardless of MELD/UKELD score.
- The scoring systems help prioritize patients based on disease severity and expected survival benefit, ensuring organs are allocated to those most likely to benefit from transplantation.
Priority and Listing
The priority on the waiting list should be based on the severity of liver disease, and the MELD score is a widely accepted and objective measure of disease severity 1.
- A MELD score of 15 or higher is a strong predictor of mortality risk and should be used as the primary threshold for referral for liver transplantation.
- Patients with very high MELD scores (over 35) should be carefully evaluated for transplantation, as the risk of mortality and morbidity after transplantation is increased 1.
From the Research
MELD Score for Liver Transplant Referral
- The Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for liver transplantation, with higher scores indicating greater urgency 2.
- A MELD score of 30 or higher is considered high-risk, with increased morbidity and mortality after liver transplantation 3.
- Patients with a MELD score of 35 or higher are considered to be at the highest risk and are prioritized for organ allocation 4.
UKELD Score for Liver Transplant Referral
- There is no direct mention of the UKELD score in the provided studies, but it is known to be used in the UK for liver transplant allocation.
- The UKELD score is similar to the MELD score but incorporates different variables, including serum sodium levels.
Referral Criteria
- Patients with a MELD score of 30-34 and severe hepatic encephalopathy should receive priority status for organ allocation, similar to those with a MELD score of 35 or higher 4.
- The MELD score does not correlate well with the severity of hepatic encephalopathy or ascites, which may affect patient outcomes after liver transplantation 5.
- A comprehensive evaluation of the patient, including medical and psychosocial factors, is necessary to determine liver transplant candidacy 6.