Liver Transplantation Candidate Classification

Determining eligibility for liver transplantation requires specific scoring systems to prioritize patients based on disease severity.

MELD Score Rationale

The MELD (Model for End-Stage Liver Disease) score is the recent and widely adopted classification system for listing patients as candidates for liver transplantation. It accurately predicts short-term mortality for patients with end-stage liver disease and is used to prioritize organ allocation.

The score is calculated using:

• Serum bilirubin
• Serum creatinine
• International Normalized Ratio (INR) of prothrombin time
• Serum sodium

A higher MELD score indicates a greater severity of illness and a higher priority on the transplant waiting list.

Other Classification Systems

While other scores exist, they are not the current primary system for liver transplant candidacy:

• Child Pugh score: An older system that assesses the severity of chronic liver disease. It is less precise than MELD for predicting short-term mortality and prioritizing transplants.
• APACHE score: This score (Acute Physiology and Chronic Health Evaluation) is used to assess the severity of illness in critically ill patients, typically in an Intensive Care Unit (ICU), but it is not specific to liver transplant candidacy.
• Metavir score: This system is used specifically to assess the degree of fibrosis and necroinflammatory activity in liver biopsies, primarily in cases of chronic hepatitis C, not for transplant listing priority.

Therefore, the MELD score is the current standard for listing liver transplantation candidates.