Transplant Medicine

Liver transplant allocation in the United States uses the MELD (Model for End-Stage Liver Disease) score, which predicts 90-day mortality without transplantation. MELD-Na incorporates serum sodium for improved prediction. Patients with the highest MELD scores receive the highest priority for deceased donor liver allocation according to UNOS policy.

Kidney transplant allocation uses the Estimated Post-Transplant Survival (EPTS) score to match donor and recipient longevity. The Kidney Donor Risk Index (KDRI) and Kidney Donor Profile Index (KDPI) quantify deceased donor kidney quality, guiding acceptance decisions and informing recipient counseling regarding expected graft survival.

Immunosuppression monitoring in solid organ transplantation includes calcineurin inhibitor (tacrolimus, cyclosporine) therapeutic drug monitoring, mycophenolic acid AUC estimation, and mTOR inhibitor (sirolimus, everolimus) level interpretation. Rejection surveillance relies on protocol biopsies, donor-derived cell-free DNA, and donor-specific antibody (DSA) monitoring.