Should Factors Such as Cost and Frailty be Considered in Transplant with MELD 40 or Higher?

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Two experts at The Liver Meeting 2016 debated if and when transplant would be futile or not in patients with a MELD score higher than 40, and both agreed more than just MELD must be considered.

“Mortality should not be the only endpoint,” Abraham Shaked, MD, PhD, from the University of Pennsylvania, said during his argument that transplant in the high MELD setting is futile. “We should minimize the economic burden on the health care system, think about where these patients are going, what are the outcomes of these patients. … I don’t like when I’m being forced to transplant MELD over 40.”

In her rebuttal, Jennifer C. Lai, MD, from the University of California, San Francisco, agreed more than MELD must be considered, but shifted her focus to other objective scores such as sarcopenia and frailty to determine the futility of a high MELD transplant.

“We need to implement objective tools … so we can identify post-transplant benefit beyond survival alone,” Lai said. “We need to start implementing these in our clinical practice.”

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