Investigating the utility of each MELD edition in predicting liver transplant outcomes

Erin Neely Burns; Oliver Roche Perrine; Victoria Jackson Comfort; June Young Lee; Danielle R Fastring

doi:10.1016/j.amjsurg.2026.116866

Investigating the utility of each MELD edition in predicting liver transplant outcomes

Am J Surg. 2026 May:255:116866. doi: 10.1016/j.amjsurg.2026.116866. Epub 2026 Feb 17.

Authors

Erin Neely Burns¹, Oliver Roche Perrine², Victoria Jackson Comfort², June Young Lee², Danielle R Fastring²

Affiliations

¹ College of Osteopathic Medicine, William Carey University, Hattiesburg, MS, United States. Electronic address: eburns580215@student.wmcarey.edu.
² College of Osteopathic Medicine, William Carey University, Hattiesburg, MS, United States.

PMID: 41719946
DOI: 10.1016/j.amjsurg.2026.116866

Abstract

Background: The Model for End-Stage Liver Disease (MELD) has prioritized liver transplant candidates since 2002, with revisions yielding 2.0 (2016) and 3.0 (2022) models. Updates aimed to enhance transplant allocation equity, but each model's ability to predict post-transplant outcomes remains unclear.

Methods: Utilizing the Organ Procurement Transplant Network database, binary logistic regression models evaluated associations between MELD cohorts and 10 post-transplant outcomes, adjusting for MELD score. MELD 1.0 served as the reference. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were reported for MELD 2.0 versus 1.0 and MELD 3.0 versus 1.0.

Results: MELD 3.0 had the most significant association with graft failure due to infection (OR = 1.30, p = 0.023), recurrent disease (OR = 0.12, p < 0.001), hepatitis (OR = 0.03, p < 0.001), chronic rejection (OR = 0.67, p = 0.041), hepatic artery thrombosis (OR = 2.51, p < 0.001), primary non-function (OR = 3.93, p < 0.001), diffuse cholangitis (OR = 2.32, p < 0.001), and overall graft loss (OR = 6.34, p < 0.001). Compared to the MELD 1.0 cohort, transplant recipients in the MELD 2.0 cohort were most strongly associated with an increased risk for acute rejection (OR = 1.58, p < 0.001) and chronic rejection (OR = 1.28, p < 0.001). While MELD 2.0 was not the strongest, it still showed significant associations with graft failure due to infection (OR = 1.162, p = 0.017), recurrent disease (OR = 0.486, p < 0.001), hepatitis recurrence (OR = 0.061, p < 0.001), diffuse cholangitis (OR = 1.523, p < 0.001), hepatic artery thrombosis (OR = 2.050, p < 0.001), primary non-function (OR = 2.869, p < 0.001), and graft loss overall (OR = 3.272, p < 0.001) compared to the MELD 1.0 cohort.

Conclusion: The MELD 3.0 cohort demonstrated significant associations with both increased and decreased risks across multiple post-transplant outcomes. These results underscore the importance of monitoring how allocation policy changes may influence post-transplant outcomes at the population level.

Keywords: Liver transplantation; MELD 3.0; MELD scores; Transplant; Transplant outcomes.

MeSH terms

Adult
End Stage Liver Disease* / diagnosis
End Stage Liver Disease* / surgery
Female
Humans
Liver Transplantation*
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Tissue and Organ Procurement
Treatment Outcome