Background Postoperative prognostic assessment is critical for patients undergoing liver transplantation (LT). The Model for End‐Stage Liver Disease (MELD) scores calculated in the early postoperative period have been shown to be associated with postoperative outcomes. While MELD‐Na and MELD 3.0 were developed to improve mortality prediction in pretransplant settings by incorporating serum sodium, albumin, and sex, their comparative utility in the postoperative period remains unclear. Methods We conducted a retrospective single‐center cohort study including adult LT recipients between January 2012 and June 2023. MELD, MELD‐Na, and MELD 3.0 scores were calculated on Postoperative Day (POD) 7. The primary outcome was 30‐day all‐cause mortality. Predictive performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Subgroup analyses were performed according to serum sodium, albumin levels, and sex. Results A total of 1038 patients were included. All three MELD‐based scores calculated on POD 7 were associated with 30‐day mortality (MELD original, hazard ratio HR 1.20, 95% CI 1.13–1.27, p < 0.001; MELD‐Na, HR 1.20, 95% CI 1.12–1.28, p < 0.001; and MELD 3.0, HR 1.21, 95% CI 1.14–1.29, p < 0.001, respectively). ROC analysis demonstrated comparable predictive accuracy across MELD, MELD‐Na, and MELD 3.0 for 30‐day mortality (AUCs: MELD original, 0.82; MELD‐Na, 0.79; MELD 3.0, 0.82; overall p = 0.24). Exploratory subgroup analyses did not identify any score with consistently superior performance across different strata of sodium, albumin, or sex. Conclusion MELD, MELD‐Na, and MELD 3.0 scores calculated on POD 7 showed comparable performance in predicting 30‐day mortality after LT. These findings support the use of POD 7 MELD‐based scores for postoperative risk stratification, with no meaningful difference in predictive performance among the three scoring systems.
Katayama et al. (2026) studied this question.