Maag-darm-lever
Model for End-Stage Liver Disease Score
Prioriteit voor levertransplantatie — voor natrium gecorrigeerde MELD.
Inhoud in het Engels
MELD-Na-score-calculator
Uitkomst
6punten
Lage prioriteit — mortaliteit na 90 dagen ~2%
Hoe je hem gebruikt
- 1
Laboratoriumwaarden binnen 24h vóór aanmelding. UNOS begrenst creatinine op 4.0 mg/dL en telt 2+ dialysesessies per week als 4.0.
- 2
Het bereik Na 125–137 telt. Natrium < 125: gebruik 125. > 137: gebruik 137 (geen effect).
- 3
MELD-Na-formule. MELD-Na = MELD + 1.32(137−Na) − 0.033×MELD×(137−Na).
Wanneer je hem gebruikt
Use in adults with known or suspected chronic liver disease, cirrhosis, or acute liver failure to estimate prognosis and prioritise liver transplantation. Also guides intensity of monitoring and ICU admission decisions.
- Toewijzing van levertransplantaten
- UNOS gebruikt MELD-Na ≥15 voor het aanbieden van postmortale organen (prioriteit boven levende donor).
- Prognose van cirrose
- MELD-Na < 10: medicamenteuze behandeling. 10–14: afwachtend beleid. ≥15: bespreken van aanmelding.
- Evaluatie vóór TIPS
- MELD > 18 na TIPS: slechte overleving. Overweeg palliatieve zorg versus transplantatie.
Over de score
The Model for End-Stage Liver Disease (MELD) score is a validated prognostic scoring system for patients with chronic liver disease, liver cirrhosis, and acute liver failure. Originally developed to predict 90-day mortality following elective TIPS (transjugular intrahepatic portosystemic shunt) procedures, it became the primary tool for organ allocation in liver transplantation in the United States (UNOS/OPTN) from 2002 and is now used by European transplant networks. MELD uses three objective laboratory values — INR, serum bilirubin, and serum creatinine — to generate a score predicting short-term mortality risk. MELD-Na (incorporating serum sodium) has improved predictive accuracy and is now preferred by many centres.
Veelgestelde vragen
What is a high MELD score?
A MELD score ≥20 indicates substantial liver disease severity with 90-day mortality risk of 20–30%. Scores ≥30 carry >50% 90-day mortality and typically require urgent liver transplant evaluation. Scores ≥40 are associated with >70% short-term mortality without transplantation.
What is the difference between MELD and Child-Pugh score?
MELD uses three objective laboratory values (INR, bilirubin, creatinine) and is the current standard for transplant prioritisation. Child-Pugh includes two subjective components (ascites severity and encephalopathy grade), making it less reproducible. MELD has replaced Child-Pugh for transplant allocation but Child-Pugh remains useful for assessing surgical risk and cirrhosis staging.
