hepatic and biliary disorders
Cirrhosis
Prognosis for Cirrhosis
Prognosis is often unpredictable. It depends on factors such as etiology, severity, presence of complications, comorbid conditions, host factors, and effectiveness of therapy. Cirrhosis was considered irreversible, but more recent evidence suggests it is reversible. Patients who continue to drink alcohol, even small amounts, have a very poor prognosis. ). The Child-Turcotte-Pugh scoring system does, however, have limitations; for example, assessments of the severity of Ascites and In contrast to the Child-Turcotte-Pugh classification, the model for end-stage liver disease (MELD) score estimates the severity of end-stage liver disease, regardless of cause, based solely on objective results of laboratory tests: serum creatinine, serum total bilirubin, and international normalized ratio (INR). The MELD score is used to determine allocation of available organs to Liver Transplantation candidates because it can sort candidates by mortality risk (see table /sex and updated the coefficients of existing variables, introduced interaction terms, and lowered the maximum creatinine to 3.0 mg/dL ( Treatment reference ). In July 2023, UNOS/OPTN switched to using MELD 3.0 to prioritize liver transplant candidates age 12 years and older. In 2019, the United Network for Organ Sharing (UNOS) implemented a major policy update on how the MELD exception (eg, HCC, hepatopulmonary syndrome) is handled. Under the new policy, patients are awarded a fixed MELD 3.0 score based on the Median MELD at Transplant (MMaT) in their region (which has a radius of 250 nautical miles), regardless of their waiting time. For patients<12 years, the corresponding pediatric end-stage liver disease (PELD) score is calculated. Higher PELD scores predict higher risk. In July 2023, UNOS/OPTN adopted a new variant of PELD score (PELD Cr), which incorporates creatinine, updated coefficients for existing variables, and the conversions of age and growth failure as continuous variables. 1.Kim WR, Mannalithara A, Heimbach JK, et al: MELD 3.0: The model for end-stage liver disease updated for the modern era.Gastroenterology161(6):1887-1895.e4, 2021. doi: 10.1053/j.gastro.2021.08.050 