Comparison of MELD, MELD-Na, and MELD 3.0 Scoring systems for transplant prioritization in the Turkish population: a multicenter study

Abstract

The Model for End-stage Liver Disease Sodium (MELD-Na) score predicts mortality in liver transplant candidates. MELD 3.0 has been proposed as an improved model for estimating mortality risk. This study evaluated MELD 3.0’s predictive accuracy for short-term mortality among Turkish liver transplant candidates and compared its performance with MELD and MELD-Na scores. Patients listed both for deceased donor transplants and living donor transplants were analyzed in the study. The discriminative abilities of MELD, MELD-Na, and MELD 3.0 scores were assessed using the area under the receiver operating characteristic curve (AUROC). Comparisons between AUROC values used the DeLong test. The most predictive cutoff for MELD 3.0 was determined using the Youden index. Transplant-free survival was analyzed using the Kaplan–Meier method, with survival curves compared using the log-rank test. A total of 1689 patients were included in this nationwide, multicenter study. Hepatitis B was the leading cause of cirrhosis (29%, n=491), followed by metabolic dysfunction–associated steatohepatitis (20%, n=335). For 3-month mortality, MELD 3.0 had the highest AUROC (0.753), followed by MELD-Na (0.747) and MELD (0.725). The most predictive cutoff values were 18 for MELD and 21 for MELD-Na and MELD 3.0. Both MELD-Na and MELD 3.0 outperformed MELD ( p <0.001), but showed no significant difference between them ( p =0.17). MELD 3.0 and MELD-Na demonstrated superior performance to MELD in predicting 3-month mortality among Turkish liver transplant candidates, though their predictive accuracy was comparable. Further refinements are needed to enhance MELD 3.0’s clinical utility.