Hematohepatology: The potential for direct oral anticoagulant “Inflation” in liver transplant candidates

The model for end-stage liver disease (MELD) score was initially developed to predict mortality following elective placement of transjugular intrahepatic portosystemic shunts [1]. The score also proved to be useful for predicting short term (90 day) survival for patients with advanced liver disease [2]. As a result, the MELD score was adopted by the United Network of Organ Sharing to help guide liver transplant allocation and prioritization in 2002 [3]. The score includes 3 widely available and standardized laboratory parameters that are objective, quantitative, and verifiable: renal function is assessed using the serum creatinine level or a fixed value for patients on dialysis, whereas hepatic function is assessed by the serum total bilirubin level (mg/dL) reflecting hepatic excretory function and the international normalized ratio (INR) of prothrombin time reflecting hepatic synthetic function.