Once included on the waiting list, patients were followed‐up by experienced hepatologists, and complications of cirrhosis were treated according to standardised therapeutic protocols as follows. 11, 12 At the time of listing, demographic, clinical and biochemical variables were collected and included in a specific database for patients awaiting transplantation. Patients belonging to Child–Pugh class A were only considered for transplantation if they had developed hepatic encephalopathy or had a concomitant parenchymal renal disease requiring combined liver–kidney transplantation. The study cohort included 308 patients with cirrhosis.Ĭriteria for listing patients with cirrhosis for liver transplantation throughout the study period were the existence of decompensated liver disease together with moderate‐to‐severe liver failure, as indicated by a Child–Pugh score ⩾7, and absence of absolute contraindications for transplantation. Patients in whom hepatocellular carcinoma was diagnosed after listing (n = 2) and those who were found to have incidental hepatocellular carcinoma at transplantation (n = 12) were not excluded from the study. Two hundred and fifty‐two patients were excluded from this study for the following reasons: hepatocellular carcinoma (n = 152), retransplantation (n = 48) or diseases other than cirrhosis (acute liver failure, n = 22 familial amyloidotic polyneuropathy, n = 18 or miscellaneous disorders, n = 12). During this period, a total of 560 patients were listed for transplantation. This is a single‐centre retrospective cohort study of all adult patients with cirrhosis listed for liver transplantation at the Hospital Clínic of Barcelona during the period between January 2000 and March 2005. The purpose of this study was to investigate these issues. However, there are several issues on the possible use of serum sodium as a predictor of prognosis that require more information, specifically: (1) whether the value of serum sodium is equally effective in the assessment of short‐term prognosis (3 months) compared with mid‐term prognosis (12 months) (2) whether serum sodium is equally accurate in predicting prognosis in different subpopulations of patients with cirrhosis and (3) whether serum sodium improves the accuracy of the MELD score. 8, 9, 10 According to the results of these studies, the use of serum sodium in the assessment of severity of cirrhosis has been recommended. In this regard, several recent studies have shown that serum sodium concentration is a good marker of prognosis in patients awaiting transplantation. 4, 5, 6, 7 Therefore, there is need for improvement of the MELD score. Nevertheless, several studies, as well as clinical observation, indicate that some subsets of patients with cirrhosis may have high mortality despite low MELD scores. 1, 2, 3 This model, which includes variables related to both liver and renal function, was implemented in the USA in 2002 and is currently being used in many countries to classify patients with cirrhosis awaiting transplantation according to the severity of their liver disease.

The model for end‐stage liver disease (MELD) score is the method most widely used for organ allocation in liver transplantation.

Meld formula