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    United Kingdom Model for End-Stage Liver Disease (UKELD)

    Predicts mortality in end-stage liver disease patients for transplant planning (UK-specific).
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    INSTRUCTIONS

    Use in context of national liver transplantation guidelines. In the UK, refer to NHS Blood and Transplant policy.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Use to determine eligibility in patients with chronic liver disease awaiting transplant.

    • Do not use in patients awaiting transplant for other causes (e.g. HCC, acute liver failure).

    • UKELD was developed and validated in a UK population and should only be considered for use in the UK.

    • It was validated in a UK population of patients with chronic liver disease awaiting transplantation. Patients with HCC were excluded.

    • A cutoff of 9% 1-year mortality was used, as this was the 1-year mortality after liver transplantation in the UK at the time.

    • Interlaboratory differences may lead to variation in end-stage liver disease scores. For example, for the transplant center Royal Free Hospital in London, creatinine clearance is weighted differently and a local correction must be used to get valid results.

    Helps decide if a patient with chronic liver disease is eligible for liver transplantation in the UK.

    mg/dL
    mg/dL
    mEq/L

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Consult a hepatologist to help determine if patient may be eligible for transplantation for reasons other than chronic liver disease.

    • For patients meeting eligibility cutoff in the UK (score ≥49), contact local transplantation center with the locally agreed upon referral system.

    Management

    Most hospitals have a particular method for transplantation referring. Typically, this is done through referral via hepatology or gastroenterology services.

    Formula

    UKELD Score = 5.395 × In(INR) + 1.485 × In(creatinine, μmol/L) + 3.13 × In(bilirubin, μmol/L) - 81.565 × In(sodium, mmol/L) + 435

    Facts & Figures

    Interpretation:

    • UKELD Score of ≥49 is the cutoff for transplant eligibility in UK, which corresponds to 1-year mortality of >9% without transplantation.
    • UKELD Score of 60 is predictive of 50% 1-year mortality.

    Evidence Appraisal

    The UKELD Score was derived by Barber et al from a prospective multicenter database of all UK-based liver transplantation centers. It included data from 1,103 adult patients awaiting their first elective liver transplantation from April 2003 to March 2006, and excluded patients presenting with acute liver failure or any type of cancer as their primary liver disease. The model was then validated on 452 patients awaiting elective liver transplantation in the UK between April 2006 and March 2007 (Barber 2011).

    The cutoff of 49 points for eligibility was decided upon as these patients had a 1-year mortality of 9% from their chronic liver disease, which is approximately equal to the 1-year mortality post liver transplantation at the time (Neuberger 2008). This is used in determining eligibility for transplantation in chronic liver disease by the NHS Blood and Transplant Service according to the liver transplantation policy (page 10, section 3.2.1, "Criteria for selection").

    Dr. James M. Neuberger

    From the Creator

    Why did you develop the UKELD Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?We wanted to create a reliable score based on robust data to predict survival of patients listed for liver transplantation in the UK. The MELD Score, a well-respected model, was developed for patients in the US and predicting survival in a slightly different cohort.

    What pearls, pitfalls and/or tips do you have for users of the UKELD Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    The score uses lab measurements which are not standardized; the components do vary and can be affected by non-liver factors. The model applies to death from liver failure and does not apply to many cases, such as cancer, hepatopulmonary syndrome, etc. Therefore, it may be used inappropriately as it is an aid, not an absolute prediction.

    What recommendations do you have for doctors once they have applied the UKELD Score?

    To use the score with common sense; to understand its strengths and limitations (such as confidence limits, effect of other factors, etc).

    How do you use the UKELD Score in your own clinical practice? Can you give an example of a scenario in which you use it?

    I use it to help patients understand their life expectancy, the need for listing or not listing, and for prioritizing patients on the waiting list.

    Any other research in the pipeline that you’re particularly excited about?

    Expanding with other parameters, looking at benefits, and extending indications so we have a dynamic model.

    About the Creator

    James M. Neuberger, MD, is an honorary consultant physician at the Queen Elizabeth Hospital in Birmingham, UK. He was the associate medical director for Organ Donation and Transplantation at NHS Blood and Transplant. Dr. Neuberger's primary research is focused on liver transplantation planning and outcomes.

    To view Dr. James M. Neuberger's publications, visit PubMed

    Content Contributors
    • Andrew Baxter, MB ChB, MRCP(UK)
    About the Creator
    Dr. James M. Neuberger
    Content Contributors
    • Andrew Baxter, MB ChB, MRCP(UK)