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Updated: Jun 19, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Comparison of Postoperative MELD-Based Scores in Predicting Mortality After Liver Transplantation: A Retrospective
Akira Katayama1,2, Ezeldeen Abuelkasem1, David W Wang1,3
1Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, pitt.edu.
Background:
Postoperative prognostic assessment is critical for patients undergoing liver transplantation (LT). The Model for End-Stage Liver Disease (MELD) scores calculated in the early postoperative period have been shown to be associated with postoperative outcomes. While MELD-Na and MELD 3.0 were developed to improve mortality prediction in pretransplant settings by incorporating serum sodium, albumin, and sex, their comparative utility in the postoperative period remains unclear.
Methods:
We conducted a retrospective single-center cohort study including adult LT recipients between January 2012 and June 2023. MELD, MELD-Na, and MELD 3.0 scores were calculated on Postoperative Day (POD) 7. The primary outcome was 30-day all-cause mortality. Predictive performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Subgroup analyses were performed according to serum sodium, albumin levels, and sex.
Results:
A total of 1038 patients were included. All three MELD-based scores calculated on POD 7 were associated with 30-day mortality (MELD original, hazard ratio [HR] 1.20, 95% CI 1.13-1.27, p < 0.001; MELD-Na, HR 1.20, 95% CI 1.12-1.28, p < 0.001; and MELD 3.0, HR 1.21, 95% CI 1.14-1.29, p < 0.001, respectively). ROC analysis demonstrated comparable predictive accuracy across MELD, MELD-Na, and MELD 3.0 for 30-day mortality (AUCs: MELD original, 0.82; MELD-Na, 0.79; MELD 3.0, 0.82; overall p = 0.24). Exploratory subgroup analyses did not identify any score with consistently superior performance across different strata of sodium, albumin, or sex.
Conclusion:
MELD, MELD-Na, and MELD 3.0 scores calculated on POD 7 showed comparable performance in predicting 30-day mortality after LT. These findings support the use of POD 7 MELD-based scores for postoperative risk stratification, with no meaningful difference in predictive performance among the three scoring systems.
