Comparison between MELD and Child- Pugh Scores for liver allocation

Background data: Liver transplantation is the best therapeutic option for patients with end- stage liver disease due to its excellent long term survival results. The demand for deceased donor liver transplantation vastly exceeds the supply. In the U.S. the Model for End Stage Liver Disease (MELD) score is now used for allocation in liver transplantation waiting lists, replacing the Child- Turcotte- Pugh (CTP) score. The MELD system is based on the risk of death without transplantation and was originally developed for survival estimation in patients after TIPS. The majority of the European countries still use the CTP score for liver organ allocation. However, there is a debate whether the MELD score is superior CTP to predict mortality in patients with cirrhosis on waiting list and after liver transplantation. Patients and methods : A cohort of 160 patients waiting for transplantation between 1994 and 2004 was evaluated. 100 of these 160 patients underwent transplantation, whereas 60 patients died on the waiting list. Treatment of decompensated cirrhosis included foremost albumin substitution, paracentesis and just mild diuretics. Under that therapeutic regiment patients showed good renal function. Therefore the well established prognostic marker in cirrhosis: renal function is widely influenced by adequate treatment. Renal haemodialysis was only necessary in few cases. 98% of the 60 patients who died before transplantation had CTP score C, whereas 62% of these were listed as prognostic good MELD status 2a. Conclusion: The meld score incorporates an evaluation of serum concentration of bilirubin, creatinine and the international normalization ratio (INR). The three laboratory parameters are dynamic parameters and may be affected by non hepatic conditions. The frequent use of diuretics in cirrhotic patients elevates the serum creatinine level without any progression of the underlying hepatic disease. Patients with signs of decompensated liver cirrhosis and good renal function, but who are in urgent need of a liver, are ill- served by the MELD based system. Therefore we conclude, based on our data, the CTP score is superior to the MELD system in allocation of organs and prediction of mortality in patients with cirrhosis on waiting list. Child - Liver allocation - MELD - end- stage liver disease