Comparison of Postoperative MELD-Based Scores in Predicting Mortality After Liver Transplantation: A Retrospective Comparative Study.

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, 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.