Use of MELD Score in Country with Low Organ Donation
Somchai Limsrichamrern MD*, Prawej Mahawithitwong MD*,
Yongyut Sirivatanauksorn MD*, Pairoj Mitmanochai MD*
Affiliation :
* Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Background : The model for end-stage liver disease (MELD) score was used to prioritize liver allocation in the USA that
decreased the mortality in awaiting patients. The current national policy for liver allocation in Thailand is to offer organs
to the transplant center, not directly to the patients themselves. The aim of the present study was to determine the accuracy
of MELD score to predict the mortality of patients on liver transplantation waiting list in Thailand, a country with low
organ donation.
Material and Method: Between January 2006 and March 2007, we prospectively collected data of all patients on liver
transplantation waiting list. MELD score was calculated. All patients were followed until they were transplanted, dead, or
to the end of the present study. Patients were then divided into three groups (dead, alive, and transplanted) according to
the outcome. Differences between groups were compared using Chi-square test.
Results : Seventy-three patients were enrolled (male:female = 48:25). Mean age was 55.6 years. At the end of the study,
44 patients were alive (60.3%, MELD 8-31), 21 were dead (28.8%, MELD 15-40), and eight were transplanted (11%,
MELD 12-30). The dead group was compared with alive group to determine mortality. Patients who died had higher MELD
score than patients who were alive. Patients with MELD score more than 15 had significantly (p-value = 0.006) higher
mortality than patients with MELD score of less than 15.
Conclusion : MELD score is very useful in stratifying severity and mortality risk of cirrhotic patients while on liver transplant
waiting list. A MELD score of 15 is associated with significantly increased mortality on awaiting patients. MELD score
should be used to prioritize liver organ in order to save lives.
Keywords : Liver transplantation, Organ allocation, MELD score, Waiting list mortality
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