Liver transplantation outcomes under the model for end-stage liver disease and pediatric end-stage liver disease

Abstract

Purpose of review Deceased-donor liver allocation has undergone a significant change in approach and execution with the adoption of the MELD/PELD (model for end-stage liver disease/pediatric end-stage liver disease) system in February 2002. This review focuses on the key reports summarising the results of this allocation system and studies examining different aspects and deficiencies of this system. Recent findings The institution of the MELD/PELD system was preceded by several important analyses in which prospective validation of the MELD and PELD models showed they had a high degree of concordance for predicting mortality risk for adult and pediatric candidates, respectively, who were waiting for liver transplantation. Additional studies documented the rationale for the policy change and outlined the specifics of the system. Results after 1 year of allocation under this new system showed a slight reduction in waiting list mortality and an increase in liver transplant rates compared with liver allocation for the year prior. Other reports examined regional differences in MELD score at transplant, the effect of changes in priority for candidates with hepatocellular carcinoma, the effectiveness of regional review boards for identifying higher-risk candidates, and variations in MELD score calculation due to international normalised ratio laboratory technique differences as well as patient survival. Summary The MELD/PELD-based liver allocation system is a much more objective system that can be quantified and studied for results. Future modifications will be made using this evidence-based approach.