*Purpose: Currently, MELD Score listing is state of the art for liver transplant recipients. Our department could show by our own institutional data and confirmed by an Eurotransplant cohort that dynamic MELD deterioration (Delta MELD) during waiting time has a significant impact on postoperative survival. Aim of this study was to analyze the risk prediction of posttransplant survival by adding recipient Sodium values to Delta MELD (Delta MELD-Na).

*Methods: More than 22000 patients of the UNOS data base were analyzed, who were transplanted in the US from 2012 to 5/2016. MELD-Na was calculated according to this formula MELD − Na − [0.025 × MELD × (140 − Na)] + 140(na ranges from 125-140) Delta MELD-Na was defined as MELD-Na at listing minus MELD-Na at transplantation: Delta MELD=MELD-Na (ON) – MELD-Na (TX)Delta MAX was the highest MELD-Na deterioration between two observation time points. Delta LAST was the alteration between forelast and last observation before transplantation.

*Results: 69.7% of patients showed a stable MELD Na during waiting time for transplantation with a maximum increase of 4 points. In 15.4% of patients an increase of 5-9 points was observed. Further 14.8% of patients showed an increase of 10 and more points. Statistical significant factors for posttransplant survival were MELD Na ON (p=0.007), MELD Na TX (p=<0.001) and Delta MELD-Na and Delta MELD-Na MAX (both p=<0.001). Delta MELD-Na LAST did not show statistical significance (p=0.35).

*Conclusions: A severe deterioration of MELD- Na during waiting time results in significantly poor posttransplant survival in liver transplantation. Also temporary deterioration during waiting showed similar risk.

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