Immediate Listing for Liver Transplantation for Alcoholic Cirrhosis: Curbing Our Enthusiasm

Liver transplantation has become the standard of care forend-stage liver disease, with 5-year survival rates ap-proaching 70 % to 80%. In the United States, allocation and timing of liver transplantation were first based on both waiting time and the Child–Pugh system. The Child–Pugh system characterizes disease severity by a scoring system involving laboratory and clinical features, as well as the physician’s subjective assessment of the magnitude of as-cites and encephalopathy, which are important compo-nents of the final score. In 2000, the Institute of Medicine recommended that disease severity, not time spent on the waiting list, should determine organ allocation in the United States. This recommendation created the need for an objective, even-handed method for measuring disease severity, which led to the introduction of the Model for End-Stage Liver Disease (MELD) in place of the Child