In an attempt to guide treatment decisions and more accurately predict long-term outcomes in ESLD, many classification schemes have been developed for clinical use. The 2 most common indices are the Child-Turcotte-Pugh (CTP) classification and the Model for End Stage Liver Disease (MELD). The CTP classification has been used widely for many years and was originally developed as a prognostic tool for determining operative risk for patients undergoing portosystemic shunt surgery. It is composed of 5 clinical variables: ascites, encephalopathy, serum bilirubin, serum albumin, and prothrombin time, and classifies patients as A, equating to a 90% chance of 5-year survival; B, equating to an 80% chance of 5-year survival; and C, equating to a median survival of about 1 year. There are problems with this classification system because some of these indices are subjective assessments and some are influenced by arbitrary cutoffs. In addition, CTP does not account for renal dysfunction, which has been shown to have prognostic importance in patients with ESLD. Despite these problems, it is useful clinically in that it can provide rapid risk assessment, easily calculated at the bedside, and has been found to correlate with HRQOL.[