Deceased donor liver transplantation survival benefit using MELD 3.0: Contemporary analysis

Results from a United Network for Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) contemporary analysis, evaluating the survival benefit of deceased donor liver transplantation (DDLT) using Model for End-Stage Liver Disease (MELD) 3.0, were published in Liver Transplantation by Jutras et al. The study included adults listed for primary single-organ liver transplantation from January 1, 2021, to March 31, 2023 (N = 21,594; n = 11,251 underwent DDLT). Mortality was compared between DDLT recipients and waitlist candidates across MELD 3.0 subgroups. 

Key data: DDLT recipients had a 95% lower adjusted mortality risk vs waitlist candidates (hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.04–0.07; p < 0.001). A survival benefit emerged at MELD 3.0 scores of 12–14 (HR, 0.54; p = 0.038) and progressively increased with higher scores (15–17: HR, 0.36; 18–20: HR, 0.35; 21–23: HR, 0.20; 24–26: HR, 0.15; 27–29: HR, 0.08; 30–32: HR, 0.06; 33–35: HR, 0.04; 36–39: HR, 0.02; and 40+: HR, 0.009; all p < 0.001). In unadjusted analyses, mortality rates were 372.7 deaths per 1,000 person-years among waitlist candidates vs 83.2 deaths per 1,000 person-years among DDLT recipients; candidate mortality increased as MELD 3.0 scores rose, while post-transplant mortality was highest at both ends of the MELD 3.0 spectrum. 

Key learning: These findings support MELD 3.0 scores ≥12 as a contemporary threshold for DDLT survival benefit, while emphasizing that MELD 3.0 alone should not determine candidacy; portal hypertensive complications, frailty, and quality of life (QoL) remain clinically relevant when considering transplant referral.