MELD 3.0: Exploring and expanding its utility beyond transplantation

The model for end-stage liver disease (MELD) score has evolved into a cornerstone of liver transplantation prioritization. With the recent development of MELD 3.0, which incorporates serum albumin and sex-adjusted variables, its predictive accuracy and applicability have expanded significantly. This review examines the potential clinical applications of MELD 3.0 beyond transplant selection, highlighting its utility as a broader prognostic tool across various hepatic and systemic conditions. Data from multiple domains suggest that MELD 3.0 provides meaningful clinical insight. In orthotopic heart transplantation, MELD 3.0 has demonstrated superior predictive power for short-term mortality and postoperative intensive care unit resource utilization. In acute variceal hemorrhage, it has maintained good discriminatory ability, although calibration challenges limit its use as a standalone tool. Among patients with hepatocellular carcinoma and renal insufficiency, MELD 3.0 has shown moderate predictive value for survival but has been outperformed by albumin-bilirubin-based models. In transjugular intrahepatic portosystemic shunt procedures, MELD 3.0 has effectively stratified pre- and postprocedural risk, enhancing dynamic patient monitoring and decisions regarding transplant timing. For alcohol-associated hepatitis, MELD 3.0 has surpassed older models in predicting mortality and the need for renal replacement therapy, particularly in women and malnourished patients. In oncology, MELD 3.0 has contributed to mortality risk assessment in hepatic visceral crisis when combined with inflammatory markers. However, its performance has been less robust in hepatic hydrothorax, where mortality has occurred at lower MELD scores, and in spontaneous bacterial peritonitis, where it has performed comparably to other MELD variants. Collectively, these findings underscore the growing relevance of MELD 3.0 as a generalizable risk stratification tool across acute and chronic liver-related conditions. Although further prospective validation is warranted, its incorporation into routine hepatology and multidisciplinary care pathways may enhance prognostic precision and inform therapeutic decision-making beyond transplantation.