Liver Intensive Care Unit, Centre Hépatobiliaire, Paul Brousse Hospital, University of South Paris, Villejuif, Paris, France.
Centre Hépatobiliaire, Paul Brousse Hospital, Inserm-Paris Sud research Unit 1193, University Paris Sud, Villejuif, Paris, France.
Semin Liver Dis. 2019 Nov;39(4):403-413. doi: 10.1055/s-0039-1688750. Epub 2019 Jun 26.
In a context of global organ shortage, the Model for End-Stage Liver Disease (MELD) score seems to be a fair prioritization tool, with a paradigm: "sickest first." Since its introduction in the United States in 2002, it has been rapidly adopted by transplant centers and organ sharing agencies around the world. The MELD score showed its effectiveness with a 12% reduction in waiting list mortality in the United States. Its success is linked to its simplicity, the use of basic variables (serum creatinine, serum bilirubin, and international normalized ratio [INR]), and its ability to predict short-term mortality, particularly on the transplant waiting list. However, this score is not perfect: its variables may have disadvantages for some patients, especially women, with serum creatinine and interlaboratory variability of the INR. The MELD score does not take into account some variables associated with poor short-term prognosis in cirrhotic patients. In addition, it is currently capped at 40, which results in the exclusion of sicker patients who could greatly benefit from transplantation. Finally, the MELD score does not accurately reflect the prognosis of several conditions, requiring a MELD exception system. Some solutions have been suggested such as MELD-Na or MELD uncapping, but it has not yet been fully accepted by all transplant centers.
在全球器官短缺的背景下，终末期肝病模型（MELD）评分似乎是一种公平的优先排序工具，其理念是“先救最危重的病人”。自 2002 年在美国推出以来，它已迅速被全球各地的移植中心和器官共享机构采用。MELD 评分显示了其有效性，使美国等待名单上的死亡率降低了 12%。它的成功与其简单性、使用基本变量（血清肌酐、血清胆红素和国际标准化比值[INR]）以及预测短期死亡率的能力有关，尤其是在移植等待名单上。然而，这个评分并不完美：其变量可能对一些患者，特别是女性患者，存在不利影响，因为血清肌酐和 INR 的实验室间变异性较大。MELD 评分没有考虑到一些与肝硬化患者短期预后不良相关的变量。此外，它目前的最高分值为 40，这导致一些病情更严重的患者被排除在外，而这些患者可能会从移植中大大受益。最后，MELD 评分不能准确反映某些情况下的预后，需要建立 MELD 例外系统。已经提出了一些解决方案，如 MELD-Na 或 MELD 无上限，但尚未被所有移植中心完全接受。
