Peak-MELD scores, a disease trajectory associated with reduced access to liver transplantation
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By
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Paul Jamme
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Julian Allgeier
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Dionysios Koliogiannis
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Markus Guba
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Christian M. Lange
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June 26, 2026
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Clinical Scorecard: Elevated MELD Scores Linked to Decreased Access to Liver Transplantation
At a Glance
| Category | Detail |
|---|
| Condition | Liver Cirrhosis |
| Key Mechanisms | MELD score dynamics influenced by infections and acute organ dysfunction. |
| Target Population | Patients with liver cirrhosis awaiting transplantation. |
| Care Setting | Liver transplantation waitlist management. |
Key Highlights
- 11% of patients experienced a peak-MELD trajectory.
- Peak-MELD scores were associated with a significantly lower transplantation rate (HR = 0.37).
- Patients with peak-MELD scores had longer median waiting times for transplantation (377 vs. 85 days).
- Infections were the predominant cause of waitlist status changes.
- Dynamic disease courses should be considered in assessing transplantation urgency.
Guideline-Based Recommendations
Diagnosis
- Regular revision of allocation criteria is necessary as diagnostic and therapeutic means evolve.
Management
- Patients with uncontrolled infections should be temporarily removed from the active waitlist.
Monitoring & Follow-up
- MELD scores should be recalculated at predefined intervals or when a higher score becomes apparent.
Risks
- Transient increases in MELD scores may reflect a clinically vulnerable disease trajectory.
Patient & Prescribing Data
109 patients newly introduced to the LT waitlist.
Recovery from infections allows for reactivation on the waitlist.
Clinical Best Practices
- Consider dynamic disease courses when assessing liver transplantation urgency.
- Monitor MELD score fluctuations closely in patients with infections.
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