What follows are excerpts from the podcast Liver Transplant – with Dr. David Gerber and Dr. Skip Hayashi [link is to the show notes and podcast]:
Dr. Ron Falk welcomes two UNC transplant experts, Dr. David Gerber and Dr. Skip Hayashi, to discuss liver transplant in the third episode of the podcast series, “Understanding Organ Transplant.” They talk about cirrhosis, the MELD score and how it is used, recovery, and more related topics. Dr. David Gerber is a Professor of Surgery in the UNC Department of Surgery and is the Chief of Abdominal Transplant Surgery. Dr. Skip Hayashi is an Associate Professor of Medicine in the Division of Gastroenterology and Hepatology, and is the Medical Director of the Liver Transplant program at UNC.
“How long will I wait?” is one of the most common questions patients ask. I tell them…a lot of it depends on how sick they are and where their MELD score is.”
– Dr. Skip Hayashi on length of wait time for a new liver
Basics of the Liver Transplant Operation
Dr Gerber: Folks with progressive disease of their liver, as he Dr Hayashi] was talking about with cirrhosis, it comes to a point where that organ is no longer going to work functionally for you, and would end up leading to an early mortality or early failure of life. Replacing the organ, something now which is part of our mainstream health care is what we talk about with transplant, it’s just that—it’s removing your entire diseased liver, and replacing it with a healthy liver from either a deceased donor or a living donor, and there are some complexities to both of those.
Waiting for a Liver & MELD Score
Dr Falk: So how long does somebody wait for a liver on the list? Let’s say it’s a deceased donor liver. What do you tell patients?
Dr Hayashi: Yes, for quite a while now—almost a decade now, fifteen years now, it’s now sickest first. Unlike other wait lists, on other organ wait lists time on the list matters—liver, not so much. It’s really sickest first, and what I tell patients is if you’re not that sick, you could still sit on the list for literally years. On the other hand, if you get sicker, your priority then will go up, and you can get a transplant within a matter of weeks, depending on how sick you actually get.
Dr Falk: How do you measure how sick somebody is? There’s a score that you use.
Dr Hayashi: That’s correct. Right now, it’s called the MELD sodium score. It’s based on four values, this was done to make it an objective and fair way to prioritize patients on the list. These four lab values are actually plugged into an equation. I tell patients they can do this themselves on the computer if they’d like—they can Google it and find it. MELD scores range from 6 to 40—they’re whole numbers.
Dr Falk: The higher, the worst.
Dr Hayashi: That’s right. If you have a MELD of 40, you’re going to need a liver pretty darn quick and if you stay there for a week or two you’re in trouble. A MELD of 6 is normal. Right around a MELD of 15, 17, 18, in general, we start thinking about, Hey, you ought to be thought about for a transplant.
Dr Falk: These are blood tests, a simple blood test that has to do a liver function test, serum sodium as well.
Dr Hayashi: And the serum creatinine function.
Dr Falk: And they’re all mixed in together with an algorithm so you can calculate the score.
Dr Hayashi: Correct. If they have these lab values, they’re standard blood tests. They don’t need to special order any.
Dr Falk: Let’s name them.
Dr Hayashi: Serum sodium, creatinine, bilirubin, and the INR which is a measure of how well your blood clots, and those are all standard blood tests anyone can order in a primary care office.
DrFalk: In a world of electronic medical records, if one got those four values, which the patient would end up being able to see, they could plug them into this calculator and understand how that MELD score and their degree of sickness and potentially their position on the list?
Dr Hayashi: They can, of course there are a lot of caveats with that. For example, the big one is if the patient happens to be on Coumadin, which is a blood thinner, that will artificially raise your INR. Therefore, that does not reflect necessarily your liver function or dysfunction. Things like that, but yes, in general it will give you a ballpark idea.
Waiting for a Liver & MELD Score
Falk: So how long does somebody wait for a liver on the list? Let’s say it’s a deceased donor liver. What do you tell patients?
Hayashi: Yes, for quite a while now—almost a decade now, fifteen years now, it’s now sickest first. Unlike other wait lists, on other organ wait lists time on the list matters—liver, not so much. It’s really sickest first, and what I tell patients is if you’re not that sick, you could still sit on the list for literally years. On the other hand, if you get sicker, your priority then will go up, and you can get a transplant within a matter of weeks, depending on how sick you actually get.
Falk: How do you measure how sick somebody is? There’s a score that you use.
Hayashi: That’s correct. Right now, it’s called the MELD sodium score. It’s based on four values, this was done to make it an objective and fair way to prioritize patients on the list. These four lab values are actually plugged into an equation. I tell patients they can do this themselves on the computer if they’d like—they can Google it and find it. MELD scores range from 6 to 40—they’re whole numbers.
Falk: The higher, the worst.
Hayashi: That’s right. If you have a MELD of 40, you’re going to need a liver pretty darn quick and if you stay there for a week or two you’re in trouble. A MELD of 6 is normal. Right around a MELD of 15, 17, 18, in general, we start thinking about, Hey, you ought to be thought about for a transplant.
Falk: These are blood tests, a simple blood test that has to do a liver function test, serum sodium as well.
Hayashi: And the serum creatinine function.
Falk: And they’re all mixed in together with an algorithm so you can calculate the score.
Hayashi: Correct. If they have these lab values, they’re standard blood tests. They don’t need to special order any.
Falk: Let’s name them.
Hayashi: Serum sodium, creatinine, bilirubin, and the INR which is a measure of how well your blood clots, and those are all standard blood tests anyone can order in a primary care office.
