Impact of MELD 3.0 Score on Outcomes After Combined Heart-Liver Transplantation: A UNOS Database Analysis

Combined heart-liver transplantation (CHLT) is performed for select patients with end-stage heart and liver disease, though the prognostic value of the Model for End-Stage Liver Disease (MELD) score in this population remains unclear.

We evaluated adult CHLT recipients between March 2005 and May 2025 from the United Network for Organ Sharing database. Groups were stratified by MELD 3.0 score at transplant: 1-14 (Low), 15-24 (Medium), ≥25 (High). Kaplan-Meier analyses assessed overall survival and freedom from liver graft failure, and Cox proportional hazards analysis evaluated risk factors for mortality after CHLT.

Among 601 CHLT patients, there were 231 Low MELD, 314 Medium MELD, and 56 High MELD. Kaplan Meier analyses showed no difference in survival or liver graft failure between the groups (p = 0.22 and p = 0.22, respectively). One-year survival for the Low, Med, and High MELD groups was 82.6% [95% CI 77.8%-87.8%], 82.6% [95% CI 78.4%-87.0%], and 90.2% [95% CI 82.4%-98.8%], respectively. Five-year survival for the Low, Med, and High MELD groups was 73.8% [95% CI 67.6%-80.5%], 76.9% [95% CI 71.9%-82.1%], and 82.0% [95% CI 71.2%-94.5%], respectively. Cox proportional hazards analysis did not show MELD 3.0 score as a risk factor for mortality after CHLT (HR 0.98, 95% CI 0.94%-1.01; p = 0.144).

CHLT recipients have comparable long-term survival and liver graft failure rates regardless of MELD 3.0 score. For all three groups, mortality risk is greater during the first year. These findings suggest that MELD 3.0 may have limited prognostic utility in CHLT and support continued consideration of combined transplantation in appropriately selected patients despite elevated MELD 3.0 scores.