The model for end-stage liver disease (MELD) score (2000) is calculated from serum bilirubin (mg/dL), serum creatinine (mg/dL), International Normalised Ratio (INR) for prothrombin time and also included the aetiology of liver disease: (zero for cholestatic or alcoholic, one score for other aetiology).5,7 Aetiology of liver was later excluded, as it did not significantly affect the MELD score. Furthermore, these parameters do not accurately identify, the most sick patient on the waiting list for LT.6 However, the minimal criteria for registering in the waiting list and for admission in an ICU, are not well defined and hence these parameters longest on the waiting list or in an ICU, are not useful. Upto 1996, allocation of organ for deceased donor liver transplant (DDLT), was based on CTP score, time on the waiting list and whether the patient is at home, in hospital or intensive care unit (ICU). In chronic liver diseases (CLD), accurate prognosis is essential, for prioritization of a patient for organ allocation for liver transplant (LT).1 Prognosis in CLD, is judged by measuring serum bilirubin (mg/dL), serum albumin (g/dL), ascites, encephalopathy, nutritional status (Child-Turcotte : CT 1964).2 Pugh (1973) modified this classification by excluding nutritional status and adding prothrombin time (CTP).3 CTP score is classified as: A (5-6), B (7-9), C (10-15), by allotting 1-3 score for each of the five parameters the higher the score (5-15), the greater the severity of CLD.3ĬTP score has some limitations: (i) assessment of degree of ascites and/or depth of encephalopathy is subjective (ii) measurement of prothrombin time in different laboratories is variable, depending on the sensitivity of the thromboplastin reagent used 4 (iii) serum bilirubin of 3 or 13 mg/dL or prothrombin time increased by 6 or 16 seconds will not alter CTP score 5 (iv) for patients on the waiting list for LT, CTP score is within a narrow range of 7-15 (Child B or C), and some patients may have identical CTP score the time on the waiting list is then taken as a tie-breaker, which is unreliable.6 Downgrading of MELD score for age of recipient and chance of recurrence of the disease is recommended to accurately predict survival after liver transplantation. MELD score is a poor predictor of survival after liver transplantation. In about 15% of patients, it does not accurately predict survival and hence MELD-Na is recommended. MELD score accurately predicts survival in 3 months for cirrhotic patients on the waiting list of liver transplantation. Model for End-stage Liver Disease (MELD) measures serum bilirubin (mg/dL), serum albumin (g/dL), International Normalised Ratio (INR) for prothrombin time.
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