The Model for End-Stage Liver Disease (MELD) score is now the standard for liver transplant prioritisation. The MELD-Na score adds serum sodium because hyponatraemia independently predicts which adverse outcome?
- A 90-day waitlist mortality independent of MELD score ✓
- B Post-transplant primary graft non-function
- C Development of hepatopulmonary syndrome
- D Hepatorenal syndrome type 1 recurrence post-transplant
Correct answer: A. 90-day waitlist mortality independent of MELD score
Explanation
Multiple studies (Kim 2008, Biggins 2006) demonstrated that hyponatraemia (serum Na <130 mEq/L) in cirrhosis independently predicts 90-day waitlist mortality beyond what MELD score captures. MELD-Na = MELD + 1.32×(137 – Na) – [0.24×MELD×(137 – Na)] + 9.57, and was adopted by UNOS in 2016 for allocation. Hyponatraemia reflects advanced aquaporin-2-mediated water retention and neurohormonal activation, not simply renal dysfunction. Post-transplant graft function and HPS are separate complications.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.