Evolution of liver transplant organ allocation policy: Current limitations and future directions

Table 1 Alternatives to the model for end-stage liver disease and model for end-stage liver disease-Na score

Test	Description	Comparison to MELD score	Ref.
MELD-GRAIL	Creatinine replaced with GRAIL	Improved 90-d mortality predictor in patients with severe disease (MELD-Na > 32), however similar to MELD-Na in patient with lesser disease severity	Asrani et al[42,43], 2019
MELD-Lactate	Addition of lactate	Better predictor of in-hospital mortality when MELD < 15 or when infection is cause of hospitalization. Similar to MELD-Na in non-infectious admissions	Sarmast et al[44], 2020
			Mahmud et al[45], 2021
MELD-Plus	Addition of albumin, total cholesterol, WBC count, age, and length of stay	Improved 90-d mortality predictor compared to MELD-Na, however can only be used after a hospital admission	Kartoun et al[46], 2017
CLIF-C ACLF	Score determined by six different organ systems failures, age and WBC count	Improved predictor of 28-d mortality compared to MELD-Na in patients with ACLF. However, only applicable for ACLF and not generalizable for decompensated cirrhosis	Jalan et al[51], 2014
			Engelmann et al[52], 2018
			Ramzan et al[53], 2020

GRAIL: Glomerular filtration rate assessment in liver disease; WBC: White blood cell; MELD: Model for end-stage liver disease; ACLF: Acute-on-chronic liver failure; CLIF: Chronic liver failure.