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Relationship between thrombocytopenia and extrahepatic metastasis of hepatocellular carcinoma: a different perspective

We read with great interest the recently published article by Khandoga et al. [1] in which the value of early posttransplant model for end-stage liver disease (MELD) scores in predicting long-term outcome after transplantation was evaluated. They concluded that early postoperative MELD scores, at postoperative day 14 for patient survival and at postoperative day 7 for graft survival, predicted outcome after liver transplantation (LTX). However, we would like to share our thoughts and contributions to this study. The MELD score, implemented by the United Network for Organ Sharing as a criterion for organ allocation in patients with chronic disease awaiting LTX, theoretically ranging in value from 5 to 40, has emerged as a useful tool that estimates mortality in patients awaiting LTX. In the literature, there are studies investigating the correlation between pretransplantation MELD scores and survival after LTX and demonstrating MELD scores to be a useful tool not only for pretransplant graft allocation but also for postoperative risk stratification [2,3]. In the studies conducted so far, it is ascertained that postoperative changes in plasma and creatinine levels, and in the international normalized ratio, which are among the MELD criteria, are different on different days and at different levels [4]. For this reason, change in MELD score rather than a single MELD score should be used in the evaluation of postoperative MELD score, especially in those evaluations including the early period; this can help obtain more valuable results. Moreover, by adding alanine aminotransferase and albumin values to the postoperative MELD scores in epidermal growth factor and graft versus host evaluations, a new scoring system that would provide more accurate information can be developed [5]. In conclusion, in the studies evaluating MELD score, one should take into consideration both the comorbidities of the patients and the accompanying metabolic disorders.