Blood Tests for the Liver Transplant Candidate and What they Mean.

Blood tests for the liver transplant candidate and what they mean. Let’s begin with the most important blood test indicator of liver health and the closest to the liver transplant. It is call the MELD score.  MELD, is a scoring system for assessing the severity of chronic liver disease. It was initially developed to predict death within three months of a certain shunt procedure, but has subsequently found to be useful in determining prognosis and prioritizing patients for receipt of a liver transplant.  This score is now used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants. The initials stand for Model for End-stage Liver Disease.  It is comprised of a combination of creatinine, bilirubin, and INR.   Creatinine is a kidney function measuring stick that is a broken down product that is filtered out of the body through the kidneys.  Bilirubin is a by product of a breakdown of red blood cells that are mainly filtered by the liver and eliminated from the system through the bowels and urine.  Elevated levels may indicate certain diseases, including cirrhosis.   It is responsible for the yellow color of bruises, urine, and the yellow discoloration in jaundice, which is yellowing of the skin.  INR, international normalized ratio for prothrombin time, is basically the time it takes the blood to clot.  In essence, the higher the INR, the more likely the liver transplant patient will bleed until normal clotting occurs.  In interpreting the MELD Score in hospitalized patients, the 3 month mortality is:

• 40 or more — 71.3% mortality
• 30–39 — 52.6% mortality
• 20–29 — 19.6% mortality
• 10–19 — 6.0% mortality
• <9 — 1.9% mortality

This is a tool that is used to determine at what point on the MELD score a liver transplant should be done.  The MELD scores for cirrhosis runs from 6 to 40.  Most schools of thought indicate a liver transplant should be performed at a score between 20 and 25.  Keep in mind that these numbers are not likely to suddenly change from say 15 to 25.  So one could say that, because of the progressive nature of cirrhosis, these number increases are gradual and relatively predictable, as long as abstinence is maintained and there no other diseases introduced that would cause an acute situation.  In the next blog, more analysis of blood test results will be presented.