The differences in listing for these two conditions is because of the very high mortality that they are associated with. If HAT occurs within 14 days after transplantation (even if it does not meet the other requirements), patients automatically get listed at a MELD of 40.įor primary hyperoxaluria, patients are listed at MMaT. Patients with HAT that occurs within 7 days of transplantation (along with AST≥3,000 U/L and at least one of INR ≥2.5, arterial pH≤7.30, venous pH≤7.25, or lactate≥4 mmol/L) get listed as Status 1A. There are two conditions (* in table above)-hepatic artery thrombosis (HAT) and primary hyperoxaluria-whereby patients are not listed at MMaT-3. She will be listed with a MELD of 28 rather than 15. Therefore, her MELD upgrade will be (31-3)=28. The median MELD at transplant for her transplant center is 31. However, she has HCC that falls within the criteria (reviewed below) necessary to achieve exception points. Patient A has a MELD score of 15 based on her labs.If patients have any of these conditions (and there are specific criteria for each one), they are eligible for an upgrade-otherwise known as an exception-in the MELD score at which they are listed.īut what does an “upgrade” or an “exception” mean?Ī MELD upgrade is defined as the median MELD score at transplant (MMaT) within a 250 nautical mile radius of the transplant minus 3. How can we best serve this particular population of patients? However, there are certain disease processes where mortality is actually higher than what would be captured by the MELD. Is everyone excited for Part 2? What are the exceptions to MELD allocation?Īs discussed in Part 1, we know that the MELD score accurately predicts short-term three-month mortality in greater than 80% of waitlisted candidates. We additionally discussed the history behind MELD, what is included in its calculation and why, and how it is used in transplant listing. In Part 1 of this series, we reviewed what came BEFORE the MELD score-Child-Turcotte-Pugh classification.
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