Meld Score

[Cindy815]

My husband has cirrhosis and had a very bad esophageal varices bleed he was in the hospital for two and a half weeks, but is doing much better now.  He also has ascites and now hepatic encephalopathy because of the bleed, both are controlled by medication. He never had HE before the bleed.   He no longer has hepatitis c, he is SVR after treatment.  My husband has gone through the evaluation for a liver transplant and we have an appointment next month with his doctor.  What I don't understand is with everything my husband has and is going through I was told his meld score is only 9.  Hector could you please explain this to me?  I don't understand why the meld score is so low with so much going on.  
  

[Cindy815]

Hector thank you for answering my question. My husband has been on a beta blocker since he was diagnosed in 2006 with cirrhosis.  He is also on meds for ascites and Lactulose for HE and hasn't had an episode since being in the hospital.  He was doing treatment for Hep C and has been undetected since December of 2014 and then had the bleed August of 2015.  He was also diagnosed with fatty liver disease.  Is his liver being attacked because of the fatty liver disease? and would that cause this issue? Thank you again, I am just trying to understand.

[HectorSF]

Yes, his fatty liver disease could be the cause of continuing  complications from his cirrhosis. As I said before most folks with cirrhosis experience a lessening of their cirrhotic complications (ascites, HE, varices, etc.) after SVR. If the only cause of their liver disease was the hep C virus, once it has been eliminated the liver begins to heal itself over time, over many years usually, this assuming of course that the cirrhosis hasn't progressed too far and become irreversible. With the addition of another form of liver disease, the already very damaged liver may be unable to heal itself and recover its normal functionality.

The only one who truly knows the answers to your questions is his doctor who has all of your husband’s history and is aware of his current liver status. I can only speculate not knowing your husband or his true medical status.

I would suggest making an appointment with his hepatologist and sitting down with her/him and have them answer your questions about your husband’s current health/liver disease status, and what his prognosis is given the current state of affairs. Of course a complete discussion about his fatty liver disease would be very important as it could have the greatest affect of his future health and any need for a liver transplant.

Unfortunately fatty liver disease is expected to replace chronic hepatitis C infection as the number one cause for folks needing liver transplants in the US in the coming years.

Take care,
Hector

[HectorSF]

Thanks for writing.

I am very sorry to hear about his variceal bleed. It sounds like a very frightening experience. I am glad he was able to recover from it. I assume he is on a beta blocker now, such as Nadolol or something similar? I treated with Nadolol myself for many years before my transplant and luckily was able to avoid any internal bleeding episodes.

I can understand your concern as his MELD score is too low. Typically at most liver transplant centers they require a minimum MELD score of 15 for listing. Of course that doesn’t exclude him from being under the care of a hepatologist at a transplant center so you have the best specialists monitoring his liver disease or an ongoing basis.

You are correct your husband’s MELD score is very low for someone with such complications from his cirrhosis. This is especially true in someone who is SVR because typically the complications of cirrhosis tend to abate after achieving SVR, once the liver is no longer being damaged from the virus on a daily basis. But the thing to keep in mind is that all people with cirrhosis are different. We are all unique and what happens to most people doesn’t mean it will happen to us.

For some people their MELD score doesn’t reflect how ill they are. This can happen with certain types of liver disease and sometimes even in people with cirrhosis caused by hepatitis C. The MELD score only measure blood levels and certain aspects of liver function. I think it is the best standard we have had but it still isn’t perfect for everyone.

I suspect something else may be going on with his liver that explains this progression of his liver disease despite being SVR. The best thing is to talk to his hepatologist and get their insight into the apparent discrepancy between his complications and his MELD score.

You may also mention his HE and its symptoms. Please review with his doctor the proper treatment of HE using Lactulose. 2-4 “loose” bowels movements per day is essential for the best management of HE symptoms. Also no red meat in his diet is important. HE can have a big impact on people’s quality of life so proper management is key.

I wish you both the best with his next doctor’s visit.
I hope this answers some of your concerns.
Hector