Liver transplantation at the age of MELD [Lebertransplantation im Zeitalter von MELD]

Liver transplantation represents a standard treatment option for irreversible chronic liver diseases. It is characterized by a shortage of donor allografts as well as by an increasing overall number of transplantations and indications, which necessitates that rationing of this therapeutic option has to occur. Since December 2006, the priority for liver transplantation is determined by the model for end stage liver disease (MELD) and not by the length of waiting time. MELD is a statistical model based on serum creatinine, serum bilirubin and coagulation, which describes the probability of 3-month mortality of a potential transplant candidate for all potential indication groups. MELD is supplemented by accepted standard exceptional categories. MELD upgrades the role of priority and need before transplantation and has led to substantial changes of the management of liver transplantation, the spectrum of indications and of post-operative mortality. The establishment and implementation of robust, objective and transparent systems to assess not only pre-operative priority but also post-operative benefit represents a major challenge for transplantation medicine. © 2009 Springer Medizin Verlag.