Allocation of donor livers through the model for end-stage liver disease (MELD) score has resulted in a fall in waiting list deaths in the United States. Change in MELD score (DeltaMELD) whilst awaiting transplant has been suggested as a method of refining organ allocation. Our aims were to analyse the effect of DeltaMELD between listing and transplant, and examine its impact on patient survival, intensive care stay and hospital stay in 402 patients transplanted for chronic liver disease at a single centre. Patients who had a DeltaMELD score of >+1 point were more likely to die in hospital following transplant (P < 0.05) and had a significantly worse 12- and 36-month survival post transplant (P < 0.0001) when compared with patients with DeltaMELD <or=+1 (77.8% vs. 91.9% at 12 months; 72.1% vs. 83.6% at 36 months). This difference persisted even when in-hospital deaths were excluded (P = 0.0148). In a Cox-proportional hazards model, factors associated with reduced survival were DeltaMELD (P = 0.008), and transplant from intensive care (P < 0.001). In conclusion, change in MELD score whilst on the transplant waiting list has a significant effect on survival post-transplant although MELD score at the time of transplant appears to have the most significant effect on resource utilization.