Medicina (Ribeirão Preto) 2013;46(2): 115-7 EDITORIAL Looking f Looking f Looking f Looking f Looking for ne or ne or ne or ne or new pr w pr w pr w pr w prognostic indices in gnostic indices in gnostic indices in gnostic indices in gnostic indices in li li li li liver tr er tr er tr er tr er transplanta ansplanta ansplanta ansplanta ansplantation. tion. tion. tion. tion. Consider Consider Consider Consider Considerations tions tions tions tions regar ar ar ar arding a r ding a r ding a r ding a r ding a resear esear esear esear esearch pr h pr h pr h pr h project oject oject oject oject Buscando novos índices prognósticos no transplante de fígado. Consi- derações a respeito de um projeto de pesquisa Nathalia Machado Cardoso 1 , Tiago Silva 2 , Orlando de Castro e Silva 3 1. Classical and pure MELD. The MELD for- mula does not fit all patients who are candidates for OLT First of all it is important to remember that the MELD is nothing more than a score used worldwide to estimate the degree of systemic involvement in patients with end-stage liver disease. The score is based on some variables such as creatinine, INR and total bilirubin and permits to classify the patients by means of a point system according to the severity of their disease. It is on the basis of the MELD score that patients who are candidates for a liver transplant are assigned to the waiting list in such a way that the more critically ill ones will receive priority. T his year we published a paper concerning liver transplantation 1 with the objective of determining the postoperative levels of classical or pure model for end-stage liver disease (MELD), and changes in lactate or base excess levels as possible predictive factors of the type of outcome for patients submitted to orthotopic liver trasplantation (OLT). This investigation motivated other studies focused on the search for sensitive predictive indices specific for the type of outcome of invariably critically ill patients submitted to the most complex surgical procedure currently performed in human beings. We intend to present here four comments that we consider pertinent with the major objective of emphasizing important aspects of the topic under study. 1. Intern Student of the HCFMRP-USP and Monitor of the division of digestive surgery, Department of Surgery and anatomy, Ribeirão Preto Medical School, USP. 2. MS Illinois Institute of Technology, Department of Applied Mathematics, Chicago, Illinois, USA. 3. Full Professor, University of São Paulo. Head of the Department of Surgery and Anatomy, Ribeirão Preto Medical School, USP. MELD = 0.957 x Log e (Creatinine*) + 0.378 x Log e (Bilirubin *) + 1.12 x Log e (INR) + 0.643 * Creatinine and Bilirubin are expressed in mg/dL. Figure 1: MELD formula: Model for end-stage liver disease