Calculates the MELD score to quantify end-stage liver disease for transplant planning.
- Consider referral to hepatologist or liver transplant center for patients with MELD score ≥10.
- MELD score should be periodically re-assessed, as it changes with changing lab values.
- All cirrhosis patients should be periodically screened for hepatocellular carcinoma with serum alpha-fetoprotein (AFP) and by appropriate imaging to see if they can earn “standard MELD exceptions”.
Standard MELD Exceptions
The following conditions are automatically assigned a MELD score of 22 (28 in case of hyperoxaluria), with a 10% increase in score every 3 months from diagnosis.
- Hepatocellular carcinoma (HCC) with one lesion between 2 - 5 cm or two to three lesions <3 cm (Milan criteria), provided no vascular invasion or extrahepatic disease.
- Hepatopulmonary syndrome with PaO2 <60 mmHg on room air.
- Portopulmonary hypertension, with mean pulmonary artery pressure (mPAP) >25 mmHg at rest but maintained <35 mmHg with treatment.
- Hepatic artery thrombosis 7-14 days post-liver transplantation.
- Familial amyloid polyneuropathy, as diagnosed by identification of the transthyretin (TTR) gene mutation by DNA analysis or mass spectrometry in a biopsy sample and confirmation of amyloid deposition in an involved organ.
- Primary hyperoxaluria with evidence of alanine glyoxylate aminotransferase deficiency (these patients requires combined liver-kidney transplantation).
- Cystic fibrosis with FEV1 (forced expiratory volume in 1 second) <40%.
- Hilar cholangiocarcinoma.