Does the patient selection with MELD score improve short-term survival in liver transplantation?

Introduction: The Model for End-Stage Liver Disease (MELD) score introduced in 2002 has come to improve selection of patients dying in the liver transplantation waiting list.

Objective: To evaluate the short-term survival in liver transplantation around the world when MELD score was applied as selection criteria. METHODS - A review has been done at the online database PubMed/ Medline/Scielo. The expressions applied for the search were "liver transplantation and/or MELD and/or survival analysis" from 2002 to 2009. Among the 124 analyzed articles, 94 were excluded due to irrelevance of the subject and lack of information. Were considered L1, L2A and MELD>20 the sickest patient; L2B, L3 and MELD< 20 the healthiest. Was compiled the data of transplanted patients, their one-year survival rate related to MELD score and compare it with pre-MELD era.

Results: MELD score has been applied, mainly in America and Europe patients, range from 8.4 to 30. One-year survival ranged from 66.5 to 92%. Analysis of patient survival rate significance between the pre-MELD and post-MELD era showed: Group I (L1 and L2A) x Group III (MELD>20), significant (p<0,0001); Group II (L2B and L3) x Group IV(MELD<20), not significant. Also, comparative one-year survival by country in the MELD era was search.

Conclusion: The MELD score have significantly improved short-term survival for the sickest patient on the waiting list for liver transplantation; additionally, it does not have any significant impact in survival for the healthiest patient.