![]() “One point is all you need to make a difference at the margin,” Kim said. Women typically have less muscle mass than men, so, on average, they tend to score 1- to 2-points lower than men, even if they have the same level of kidney dysfunction. Muscle mass affects the body’s level of creatinine. “Women have been disadvantaged in this system, and that was a completely unintended consequence of this score.” “People have shown that the transplant rate for women is lower and waiting list mortality is higher,” Kim said. In recent years, data has revealed a new concern with MELD scoring: sex disparity. We were able to allocate organs to people who need it most,” Kim said.Ī 2016 update to the score, which was also based on work by Kim, added sodium to the formula and is known as MELDNa. “It really shuffled the waiting list, reduced the risk of waitlist mortality and increased transplants. It incorporated three common blood test values - bilirubin (a measure of liver damage), creatinine (a measure of kidney function) and the INR (international normalized ratio, a measure of blood clotting time) - to calculate a score between 6 and 40, with higher scores for sicker patients. The MELD system provided an objective way to prioritize candidates based on their predicted survival on the waitlist. “The federal government gave a mandate to the transplant medicine community to come up with an objective measure of medical urgency to allocate organs in a scientific fashion,” Kim said. Many of the sickest patients never got their turn. In the 1970s, liver transplantation was an experimental procedure, but as it evolved into an established treatment for liver disease by the 1990s, the number of people waiting for a liver began to far outpace the number of available livers, which mostly came from deceased rather than living donors. Prior to that, Kim said, liver transplants were performed on a first-come, first-served basis. Twenty years ago, as an assistant professor at the Mayo Clinic, Kim directed the team that created the original MELD score. Ray Kim, MD, professor and chief of the Division of Gastroenterology and Hepatology, led the team that developed MELD 3.0, but his history with the scoring system dates to its beginning. In June, MELD 3.0 was unanimously approved by the board of directors of the Organ Procurement and Transplantation Network, which governs the U.S. Recent concern over the accuracy of the MELD score, including a sex disparity that disadvantages women, prompted Stanford Medicine researchers and collaborators to develop a new version of the score, called MELD 3.0. The goal is to minimize waitlist deaths by moving the sickest patients to the head of the line. Placement on the list largely depends on a number called the MELD (model for end-stage liver disease) score, which estimates the short-term risk of death in patients with chronic liver disease. Every year, some 13,000 people are added to the liver transplant waiting list in the United States, but fewer than 9,000 receive a liver.
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