Meld score

[mancona]

My husband has a meld score of 20 and a CTP score 11 (I personelly don't like this meld scoring) my question is does anyone know how serious this listing is? I can not find any mortality info on this score or any info on where his placement would be on the list, clearly there is a great difference between CTP Meld. Any info would be appreciated

[imkindly]

Hi Mike
That's GREAT that you're involved with helping others. :)
((((And Congratulations on your transplant!))))
My husband has HCV, and got his transplant in Nov. 2002.....we're coming up on his 1 year anniversary soon.

[Prankster]

Hey imkindly,

I just discovered this board and the MELD CTP score thread caught my eye.  I wanted to tell you that your comments are much appreciated by me.  I'm 8 years post liver transplant due to HCV.  I was diagnosed in 92 and by 94 was on the list at OHSU.  The science around HCV was so new that I never really knew much except I needed a liver and got one.  I've been a member (off and on) to HEPV_L since the PlanetMaggie days so I've gained some knowledge over the years but haven't paid much attention since it was not relevant to my situation.

For the last year I've worked as an outreach worker to Injection Drug Users and I've become more interested in gaining some knowledge about current science surrounding the disease.  

Again, I appreciated your comments and thank you for them

Peace,
Mike

[mancona]

thank you so much for your information, you explained it very clearly for me and I now feel somewhat calmer. It is a very scary position to be in at the moment, and I am trying to read everything I possibly can on the this subject, sometimes it's just too much information and it overwelms me. Thank you also for the links.

[imkindly]

Hi Mancona

The CTP score is used to tell WHAT STAGE of cirrhosis a person is in.
Score of 5 to 6 = Stage A
Score of 7 to 9 = Stage B
Score of 10 to 15 = Stage C (end stage)

When a person reaches a CTP score of 7 or above----their doctor should refer them to a transplant center for an "evaluation".

----An "evaluation" is a series of tests and interviews, to determine whether a patient is a good candidate for a liver transplant.
----Once a person passes the evaluation, they are placed on the Liver Transplant Waiting List.

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AFTER a person has passed their evaluation, and been placed on the Liver Transplant Waiting List.......
The MELD Score is used (to see who gets the next available liver)

MELD scores range from 6 to 40.
MELD scores are calculated by using the results of 3 bloodtests:
1. Total Bilirubin
2. INR
3. Creatinine

As a person gets sicker and sicker....their MELD Score rises.

UNOS (the people in charge of liver allocation and the waiting list) wants the next available DONOR LIVER to go to the sickest person on the waiting list.
Therefore--- The person with the highest MELD Score gets the next available donor liver.

Each transplant center has their own group of patients on the waiting list.
You are competing with the people at YOUR center, with YOUR blood type.

Here's an example:

Say you have a MELD score of 20, and your blood type is type O

Say 'Joe Smith' has a MELD score of 22, and he's also type O

-----Joe Smith is sicker than you. So when a Type O liver becomes available FOR YOUR CENTER, Joe will get the call.


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It's important for you to ask your doctor:
"What is the average MELD score to get a transplant HERE AT THIS CENTER?"

(Your doctor WILL have a good idea of the answer, because all they have to do is look to see the highest MELD waiting at YOUR center)

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My husband got his transplant at Baylor Methodist in Houston Texas.
His MELD Score was 23 when we got the call.

I have met people online from Indiana, who got the call when their MELD score was les than 20.

It all depends on YOUR CENTER, how many people of your same blood type are waiting at THAT CENTER, and how high their MELD Scores are.
(You are competing against the people with the same blood types as you...at YOUR CENTER)

[imkindly]

We have a Support Group online at

http://www.expage.com/cirrhosis

You're welcome to visit there. We have a messageboard (with others in your same situation)
We also have live chats every Wednesday evening.

Here's some posts from that messageboard that may be helpful to you:

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CTP- Child Turcotte Pugh Scores explained:

http://forums.delphiforums.com/liverfailure/messages?msg=112.1

(you can scroll through several posts there)

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UNOS Policies regarding MELD and liver allocation:

http://forums.delphiforums.com/liverfailure/messages?msg=649.1

(you can scroll through several posts there)

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MELD Score Calculator:

http://forums.delphiforums.com/liverfailure/messages?msg=2080.1

(you can scroll through a few posts there)


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[mancona]

thank you so much for responding to my post, I have been going crazy trying to find any info on this MELD it is so confusing to me, but I know that what I see in my husband is not good, and I don't want numbers to look like he is doing better then he really is. Just very worried at this point. Thank you again for your response

[jamit_a]

Hi,
I'm not a doctor but, if I read correctly the score of 20 is not good. I would ask your GI or doctor for a more accurate assessment, and his opinion.

Division of Gastroenterology, Scott and White Clinic, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA. ***@****

BACKGROUND: Alcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality. Specific therapies should be considered for those at high risk of mortality. The Mayo End-Stage Liver Disease (MELD) score is a marker of disease severity and mortality in persons with chronic alcoholic liver disease. Our aims were to assess the utility of the MELD score as a predictor of short-term mortality in persons with alcoholic hepatitis. METHODS: We assessed the utility of the MELD score and compared it with the Discriminant Function (DF) as a predictor of mortality in 34 patients hospitalized with alcoholic hepatitis. RESULTS: The area under the curve of a receiver operating characteristic curve for the MELD score was 0.82 (confidence intervals 0.65-0.98), and for the DF was 0.86 (confidence intervals 0.70-1.00). However, the sensitivity and specificity in predicting 30-day mortality for a MELD score of greater than 11 was 86% and 81%, but for a DF greater than 32 was 86% and 48% respectively. The presence of ascites and bilirubin greater than 8 mg/dL were also highly predictive of mortality with a sensitivity of 71% and a specificity of 96%. CONCLUSIONS: Alcoholic hepatitis remains associated with a high mortality in hospitalized patients. The MELD score performs as well as the DF in predicting mortality at 30 days. A MELD score of greater than 11, or the presence of both ascites and an elevated bilirubin greater than 8 mg/dL should prompt consideration of specific therapeutic interventions to reduce mortality.

Best of luck and God bless,
Jamit_a
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