Liver Transplantation for the Patient with High MELD

  • Cynthia Wang
  • Randolph Steadman


The model for end-stage liver disease (MELD) score has been used for more than 15 years for the allocation of liver grafts in the U.S. and many other countries. As a results liver transplant recipients have been sicker and presented with more severe liver disease. Patients with severe, decompensated liver disease pose a challenge for the anesthesiologist as most organ systems are usually affected. This chapter will review management strategies and common complications of liver transplant recipients with high MELD scores.

The Model for End-Stage Liver Disease (MELD) Score

MELD is a system for scoring the severity of liver disease. The model was developed in 2000 to predict survival in patients undergoing transjugular intrahepatic portosystemic shunt placement. In 2002, the Organ Procurement and Transplantation Network adopted the MELD score as the standard for prioritization of graft allocation for liver transplantation [1, 2, 3]. With few exceptions (hepatocellular...


MELD score Renal insufficiency Outcome Transfusion Organ allocation Futility 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain ManagementVA North Texas Healthcare SystemDallasUSA
  2. 2.Department of Anesthesiology and Perioperative MedicineUCLA HealthLos AngelesUSA

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