What is the MELD score?
While waiting for a liver transplant, the United Network for Organ Sharing (UNOS) mandates that the MELD (Model for End Stage Liver Disease) Score is used to determine your rank on the waiting list, which is a reflection of the urgency with which you need a liver transplant. This score is made up of 4 lab tests
- How effectively liver excretes bile (Bilirubin)
- How well the liver can produce blood clotting factors (INR or prothrombin)
- Relates to bruising and easy bleeding
- The current function of the kidney (Creatinine)
- An electrolyte that is a marker for significant liver disease (Sodium)
Learn more about the MELD score system at Penn Medicine
MELD ranges from 6 to 40 and is a measure of how severe is patient’s liver disease is. However, some patients’ severity of illness or risk of complications are not captured by the MELD score. For this reason, there is a system of exception points in place (known as MELD exception) to give those patients with certain conditions a standard score on the United Network for Organ Sharing (UNOS) transplant waitlist.
What can I get MELD exception for?
Patients may qualify for MELD exception for the following conditions:
- Hepatocellular Carcinoma (HCC) - the most common type of liver cancer for which patients get listed for transplant
- Cholangiocarcinoma (specifically hilar cholangiocarcinoma) - cancer of the bile ducts
- UNOS requires the transplant institute submits a written protocol in order to transplant patients with this exception; Penn Medicine has an approved protocol at this time.
- Cystic Fibrosis (CF) - a hereditary disorder causing production of abnormally thick mucus and can require lung transplant and often liver transplant (at the same time)
- Hepatopulmonary Syndrome - a condition in patients with advanced liver disease; symptoms include shortness of breath and low oxygen levels
- Familial Amyloid Polyneuropathy - inherited disease that causes peripheral nerve degeneration; often (but not always) requires combined heart-liver transplant
- Portopulmonary Hypertension - high blood pressure in your lungs associated with portal hypertension- more commonly seen in patients with liver disease
- Primary Hyperoxaluria - genetic condition in which patient has a buildup of oxalate, resulting in the need for a combined liver-kidney transplant
How does the MELD exception work?
To qualify for an exception, each of the conditions listed above has specific guidelines, which require diagnostic testing, blood work, and genetic markers. Your transplant coordinator can go over the specifics if you are diagnosed or if you have any of these genetic conditions.
In addition, each exception must be re-certified, or re-reported to UNOS, every three months with updated information. The updated Information is diagnosis-specific. For instance, HCC requires an updated MRI or CT abdomen and an AFP (tumor marker) every three months. CF requires no new additional information once the first exception has been submitted; we simply need to re-verify every three months that the patient remains listed with a diagnosis of CF.
How is my exception score determined?
Patients who are listed with MELD exception are listed with what is known as MMaT-3. MMaT stands for Median Meld at Transplant, and it is a calculation derived from all transplants done within 250 nautical miles of your program over the last 365 days. The median is the middle number—meaning 50 percent of those MELD scores are above and the other 50 percent are below—resulting in the final median MELD score at the time of these transplants.
Patients with primary hyperoxaluria receive an exception score of MMat or the median. All other exception categories receive 3 points less, or MMaT-3. For example, if the median at your center was deemed to be 30, primary hyperoxaluria patients would be listed with a 30. Any other exception type would be listed with a 27.
MmaT is recalculated every six months based on the transplants done in the past year. Please speak with your transplant coordinator to find out our program’s current MMaT.
The Penn Medicine Approach to MELD Exception
To help patients remember when they are due for an exception, our team of medical assistants and transplant coordinators will make reminder calls to ensure the diagnostic testing and blood work needed for an exception is complete prior to your recertification date.
If you would like more information about MELD exception or have questions about the wait list, please contact your pre-transplant nurse coordinator at 215-662-6200.
Learn more about the Penn Liver Transplant program