It's not all about the MELD Score

Posted by amyintucson @amyintucson, May 19, 2018

There are lots of threads out there with questions and comments about MELD Scores. I just had my 1year/3 month pre-liver transplant review and my MELD is a 10. The doctors at Mayo/Phoenix emphasized that the MELD isn't everything as some people are sicker than their scores indicate. They have me on the "active" list and am in the discussion at their weekly team meetings. I have venous congestion that is of major concern because if it continues to grow it causes other operative problems. I have had esophageal varices banded - 6-8 times (no bleeding so far) - but that has precluded using a blood thinner to allow the body to dissolve the clot on its own. If my next upper endoscopy - in the next 2 weeks here in Tucson - shows no new varices we may try the blood thinner even with my low platelet counts. Though it increases the risk of bleeding, with weekly monitoring its a risk/reward decision. The bloid thinner will likely raise my INR and temporarily raise my MELD, it's worth a shot if the body breaks up the clot.

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Hi Rosemary
I have had frank conversations with my liver doctor and I continue to be hopeful. I do service work for AA, giving rides, and meeting with those who request it. I take my meds and have blood work done monthly. I also do a weekly urinalysis for drugs and alcohol. Patients who test positive are often dropped from the transplant list, per most insurance companies. I am in the best shape of my life, ironically since I almost drank myself to death. I know that at some point, my health may decline to the point where I need a transplant. Until than, I will continue to live a productive, healthy life, and will deal with symptoms as they appear. Ideally I would love my liver to heal itself so that I do not need any further intervention. My doctor has made it clear that my liver is not viable and at some point it will need to be replaced. I will deal with that if / when that point arrives. As all patients, I do live with that anxiety over when that point arrives. Thank you for your response.

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@johnshaw

Hi Rosemary
I have had frank conversations with my liver doctor and I continue to be hopeful. I do service work for AA, giving rides, and meeting with those who request it. I take my meds and have blood work done monthly. I also do a weekly urinalysis for drugs and alcohol. Patients who test positive are often dropped from the transplant list, per most insurance companies. I am in the best shape of my life, ironically since I almost drank myself to death. I know that at some point, my health may decline to the point where I need a transplant. Until than, I will continue to live a productive, healthy life, and will deal with symptoms as they appear. Ideally I would love my liver to heal itself so that I do not need any further intervention. My doctor has made it clear that my liver is not viable and at some point it will need to be replaced. I will deal with that if / when that point arrives. As all patients, I do live with that anxiety over when that point arrives. Thank you for your response.

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@johnshaw It sounds as if yes, a transplant is in your future but not immediate future. I too was anxious and actually thought of not having one, but as my condition worsened it changed my mind. Now, being post-transplant by 2.5 years, I think how crazy I was to not want one. My life is so improved. Sure, there are some difficulties due to the immunosuppressants, but I can live with those relatively small problems.
From what I have read, the vast majority of patients who have liver transplants have few problems afterward, and as long as you keep up doing as you are, staying in shape, etc., then I am sure you will be the same. I worked hard at getting into better shape prior to my liver transplant and it really did make a difference.
JK

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@rosemarya

Hi, @johnshaw. I am a transplant recipient. I received both liver and kidney simultaneously from the same deceased donor. That was in 2009. I was diagnosed with liver disease almost 8 years before I became a transplant candidate. If my memory serves correctly, my score was mostly steadily rising. In all honesty, I never paid any attention to that number because how I felt told me what I needed to know. I was more concerned with trying to maintain some level of physical activity and to combat the excessive nausea as well as itching and ascites. I can understand how you feel as you are living with the unknowing. I want to congratulate you for your strength to overcome your alcohol dependence and to develop a new healthy lifestyle. That will be a major benefit as you move forward with whatever path your liver takes.
I hope that you looked at the information that was posted earlier that says "Since your health condition can change frequently, your doctor will send you to the lab for updated blood work routinely, so they can assess your condition often"....The MELD Score: Definitions and Frequently Asked Questions https://connect.mayoclinic.org/page/transplant/newsfeed-post/the-meld-score-definitions-and-frequently-asked-questions/
I am sorry that you feel so poorly, but it sounds like your doctor is keeping a close watch on your liver. Will you keep us updated?
I have always been told that all liver disease has some similarities, yet no two of us are alike in what we experience. The best we can hope for is to be patient and to do everything to promote out best healthy living during the difficult journey so that we are helping our bodies prepare for eventual surgery.
I am happy that you have joined our fellowship! I invite you to brouse thru all of the discussions and to know that you are welcome to join in anywhere.
What has your doctor said she wants to learn from the sonogram at end of May?

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@rosemarya
Well I am wondering if the Drs have any clue what path this disease will take. Going to my hep Dr tomorrow and that is one of my many questions for her.
The itchiness from excema is gone for now...but still on the fri ge. Now they are concerned about my heart so I have a heart monitor for 14 days and a catherization next Wed. Oh yes..a sleep study and test too.
The MRI I had at Mayo was all good except for a spot they found on the lung..ultrasound cleared that...
.whew!
If they could only tell me what comes next.....that doesnt happen with this disease...we are all different. PS I am very fortunate to be a patient of the transplant team at Tampa General Hospital and Mayo Jax Transplant team. I have meld of 6 down from 8. So, I know Im getting very good care and they traet me as if my meld were 20. Not on the hot list deemed too early.

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@jeanne5009

@rosemarya
Well I am wondering if the Drs have any clue what path this disease will take. Going to my hep Dr tomorrow and that is one of my many questions for her.
The itchiness from excema is gone for now...but still on the fri ge. Now they are concerned about my heart so I have a heart monitor for 14 days and a catherization next Wed. Oh yes..a sleep study and test too.
The MRI I had at Mayo was all good except for a spot they found on the lung..ultrasound cleared that...
.whew!
If they could only tell me what comes next.....that doesnt happen with this disease...we are all different. PS I am very fortunate to be a patient of the transplant team at Tampa General Hospital and Mayo Jax Transplant team. I have meld of 6 down from 8. So, I know Im getting very good care and they traet me as if my meld were 20. Not on the hot list deemed too early.

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@jeanne5009, I hope that you get some good news tomorrow with your hep Dr. I think that it might be a good thing that you are not on the list yet, because all of these complications would cause you to be inactivated. So maybe it is best that you can get everything addressed now while your liver is maintaining itself.
I used to use the analogy of a row boat that kept popping new holes as fast as the old ones could be plugged. On my good days I could picture an old cartoon image. At least the boat never sank, but it was hard work to keep it afloat.

Stay strong. You are in good care.

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@rosemarya

@jeanne5009, I hope that you get some good news tomorrow with your hep Dr. I think that it might be a good thing that you are not on the list yet, because all of these complications would cause you to be inactivated. So maybe it is best that you can get everything addressed now while your liver is maintaining itself.
I used to use the analogy of a row boat that kept popping new holes as fast as the old ones could be plugged. On my good days I could picture an old cartoon image. At least the boat never sank, but it was hard work to keep it afloat.

Stay strong. You are in good care.

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Yes I agree...the good news is that eveything they have checked was fine
The cardiologist who is head of the heart transplant group at TGH is doing the procedure and has assured me that it wont have any impact on my waiting. He said if there is something going on they will fix it while they are in there. Mayo has agreed to the procedure.
I think they are checking all the weak links before they list. We will see. Know more tomorrow.

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@jeanne5009

Yes I agree...the good news is that eveything they have checked was fine
The cardiologist who is head of the heart transplant group at TGH is doing the procedure and has assured me that it wont have any impact on my waiting. He said if there is something going on they will fix it while they are in there. Mayo has agreed to the procedure.
I think they are checking all the weak links before they list. We will see. Know more tomorrow.

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@jeanne5009 That is good news, that everything they have checked is fine. Be confident that they will fix whatever they need to so that a transplant will be possible. I was so afraid that something would be found when I was going through all of the tests but they assured me that if anything did come up they would take care of it.

I am a little confused, you are going to Mayo for tests but when you get to the point of transplant it will be at Tampa? It sounds as if there are a number of good transplant hospitals in Florida. When I first started at Mass General they told me that they generally transplanted at a higher MELD and suggested that I might want to look into hospitals in Florida and Indiana. I had talked to them at Mayo in MN and was just about to move forward when my transplant came through in Boston at MELD 28. That was a very Hallelujah moment.
JK

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@hogan_g1937

My husband has a MELD Score 30. Even though his MELD is considered to be high and possibly first on the transplant list he is not physically sick. It has been a couple of years since he has been hospitalized with HE and Ascites. Yes he is in a lot of pain most days and he push through it. He does drive, keep the yard cut and just about anything he wants to do. So I guess the MELD does not mean the sickest. Just a little confused about the MELD and what it really means as far as your overall health and placement on the transplant list.

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I am happy to say that I am nine months post transplant with no complications. I had Asophagial varasies ten plus years ago and nearly bled out. I developed Acidies 7 months into apstaning from Alcohol consumption and learned during one of two parasyntethys hospitalizations that I had a meld score of 27. I was told by my liver specialists that I had end stage Liver disease. He referred me to a transplant surgeon. Before I could be evaluated for a liver transplant. I contracted E-Coli and my Meld core caped at 40. I was told I was in the 45 range. I was transferred to a transplant hospital were I was put on the transplant list and received a gift of life within three days. Just the other day I opened a letter from the hospital informing me my Meld score is 40 and I will not be leaving the hospital without a liver transplant.10 months late. GOD BLESS!

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@luckonetj

I am happy to say that I am nine months post transplant with no complications. I had Asophagial varasies ten plus years ago and nearly bled out. I developed Acidies 7 months into apstaning from Alcohol consumption and learned during one of two parasyntethys hospitalizations that I had a meld score of 27. I was told by my liver specialists that I had end stage Liver disease. He referred me to a transplant surgeon. Before I could be evaluated for a liver transplant. I contracted E-Coli and my Meld core caped at 40. I was told I was in the 45 range. I was transferred to a transplant hospital were I was put on the transplant list and received a gift of life within three days. Just the other day I opened a letter from the hospital informing me my Meld score is 40 and I will not be leaving the hospital without a liver transplant.10 months late. GOD BLESS!

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@luckonetj, Welcome to Mayo Connect! Thank you for sharing your exciting success story here! Congratulations on your transplant!

Are you interested in any post transplant tips? I invite you to join me and others in: Self-Care Tips for Transplant Patients
https://connect.mayoclinic.org/page/transplant/newsfeed-post/self-care-tips-for-transplant-patients/
As a recipient, I am especially thrilled to celebrate your successful transplant. You have had quite a pretransplant journey, How has your life changed since your life changing event 9 months ago?

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@luckonetj

I am happy to say that I am nine months post transplant with no complications. I had Asophagial varasies ten plus years ago and nearly bled out. I developed Acidies 7 months into apstaning from Alcohol consumption and learned during one of two parasyntethys hospitalizations that I had a meld score of 27. I was told by my liver specialists that I had end stage Liver disease. He referred me to a transplant surgeon. Before I could be evaluated for a liver transplant. I contracted E-Coli and my Meld core caped at 40. I was told I was in the 45 range. I was transferred to a transplant hospital were I was put on the transplant list and received a gift of life within three days. Just the other day I opened a letter from the hospital informing me my Meld score is 40 and I will not be leaving the hospital without a liver transplant.10 months late. GOD BLESS!

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@luckonetj I too welcome you to Connect. You had quite a journey along the way to transplant. It sounds as if it was a very good thing that you were already in the hospital when a liver became available.
I am also post-liver transplant, I received my transplant in September 2016 and have done great post-transplant.
@rosemarya asks some interesting questions. I hope we hear from you some more.
JK

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My labs Friday were excellent. Saturday was my 8 mo sobriety date and Sunday my Doc called me. Fathers Day. She indicated my liver function is improving and if my labs continue to improve by August, she may take me off the liver transplant list. My Meld was 26 in Jan now it is less than 12. I’ve changed my lifestyle completely.
Clean from drugs and alcohol, vegetarian diet, running up to 5 miles a day. It feels good being this healthy.

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