*Purpose: MELD 3.0 is a recently proposed model that improves upon MELD-Na, incorporating sex and albumin as additional variables, updating existing coefficients and adding relevant interactions, and resetting the upper bound of serum creatinine to 3.0 from 4.0 mg/dL. Conventionally, MELD is capped at 40 in the liver allocation system, and waitlist priority in case of ties is then ordered by waiting time. This study evaluates the impact of MELD-Na and MELD 3.0 scores beyond this threshold on waitlist mortality among liver transplant candidates.

*Methods: New adult waitlist registrations for liver transplantation from January 15, 2016 to June 30, 2021 were identified using OPTN data. MELD-Na, and MELD 3.0 scores from registration were calculated, and differences in waitlist and post-transplant mortality by MELD strata 40, 41-45, 46-49, and 50+ were assessed.

*Results: There were 68,086 new waitlist registrations for liver transplantation during the study period, 3213 (4.7%) with MELD-Na ≥40 and 3875 (5.2%) with MELD 3.0 ≥40. Short-term waitlist mortality was higher for each increasing MELD 3.0 stratum, from 52.6% at 30 days to 90.5% at 30 days for those with MELD 40 compared to MELD >50 (Table). One-year post-transplant outcomes were comparable across MELD strata.

*Conclusions: MELD 3.0 is anticipated to increase the proportion of patients reaching or surpassing the maximum allocation score of 40. Patients with MELD >40 may derive greater survival benefit from LT compared to MELD 40. Uncapping MELD 3.0 improves risk stratification of waitlist mortality and better represents urgency for liver transplant for the sickest patients including those with acute-on-chronic liver failure.

« Back to 2022 American Transplant Congress