MELD score

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The MELD score ( Model for End-stage Liver Disease ) indicates the severity of a liver disease. It was introduced in 2002 by the United Network for Organ Sharing (UNOS), a US organ transplant company, acquired by Eurotransplant in 2003 and is used to give priority to donor organs to patients with severe liver damage .

The MELD score is based on three laboratory parameters filtered out by scientists at the Mayo Clinic in the USA as the most reliable predictors of the course of severe liver disease requiring a transplant (and thus the relative severity of the disease and the expected remaining life span):

Bilirubin , creatinine and blood clotting time, the latter measured using the INR ( international normalized ratio ). The MELD score is calculated from these parameters as follows:

10 × (0.957 × ln (serum creatinine [mg / dl]) + 0.378 × ln (total bilirubin [mg / dl]) + 1.12 × ln (INR) + 0.643).

If dialysis was performed within the last week , the creatinine value is set equal to 4.0. The score is rounded to the nearest whole number and is between 6 and 40 points. The higher the value, the higher the likelihood of dying within three months without a transplant. There are adaptations for patients with tumors.

In the case of specific underlying illnesses, there is also the so-called exceptional MELD, since with certain illnesses the sole calculation of the MELD score often does not do justice to the actual need for a donor organ. This puts these people at a disadvantage compared to patients with alcohol or virus-induced liver cirrhosis. To compensate for this, there are "extra points" in the form of the exceptional MELD for certain complications. A patient with primary sclerosing cholangitis (PSC) achieves this, for example, if two of the following three criteria apply: dominant bile duct stenosis (narrowing of the main bile ducts ), reduction in BMI by more than 10% within 12 months and / or with two biliary sepsis episodes in 6 Months. Further details are regulated by the regularly adapted guidelines of the German Medical Association for organ mediation for liver transplantation.

literature

  • H. Schmidt: Liver transplantation: a fair chance for everyone. In: Deutsches Ärzteblatt . 104, issue 34–35, August 27, 2007.
  • R. Wiesner et al: MELD and PELD: application of survival models to liver allocation. In: Liver Transplant . 7 (7), 2001, pp. 567-580.
  • R. Wiesner, E. Edwards, R. Freeman et al. And the United Network for Organ Sharing Liver Disease Severity Score Committee: The model for end-stage liver disease (MELD) and allocation of donor livers. In: Gastroenterology . 124, 2003, pp. 91-96.
  • PS Kamath et al: A model to predict survival in patients with end-stage liver disease. In: Hepatology 33 (2), 2001, pp. 464-470.
  • Guidelines for waiting lists and organ placement for liver transplantation (RiliOrgaLeber; PDF file)

Web links

Individual evidence

  1. ↑ Christian P. Strasbourg Susanne Beckebaum, Andreas Geier Daniel Gotthardt Reinhild Klein Michael Melter Eckart Schott Ulrich Spengler Frank Tacke Michael Trauner, Christina Weiler-Normann Tobias J. Weismüller Andrea Tannapfel Jens J. Tischendorf Christoph Schramm: S2k-Leitlinie 021/027: Autoimmune Liver disease . Ed .: German Society for Gastroenterology, Digestive and Metabolic Diseases.