Additional information

MELD 1.0: The cohort of patients used for this analysis included adults (18 years of age) with chronic liver disease who were added to OPTN liver waiting list at a 2A or 2B status between November, 1999, and December, 2001. Of the 6651 adult patients with chronic liver disease who were listed during this time period, 3437 (52%) had complete MELD data at the time of listing, including serum creatinine, serum bilirubin, and INR. Because prothrombin time rather than INR was often reported for patients at listing, these patients were excluded for purposes of this analysis because of the variability in the methods used for determining prothrombin time. Of the 3437 patients with complete data, 1040 underwent liver transplantation before 3 months of follow-up, and 126 patients were removed from the OPTN list. Of those removed, 95 patients were judged to be too sick to undergo the liver transplant procedure. Of the remaining 2271 patients, 1859 patients survived, and 412 died during the 3-month follow-up period.

MELD Na: The updated analyses included all candidates added to the liver transplant waiting list between January 1, 2007 and December 31, 2010, excluding candidates younger than 12 years of age, those with a previous liver transplant, candidates listed as Status 1, and those with a history of malignancies. Data for candidates added to the list in 2009-2010 were used to refit the equations; data from those added in 2007-2008 were used to validate the refit equation. The components of the current MELD score (serum bilirubin, serum creatinine, INR) plus serum sodium (all from the time of waitlist registration) were used for refitting the equation.

MELD 3.0: The main portion of this analysis was performed on the OPTN Standard Transplant Analysis and Research (STAR) files with data curated as of 03/15/2019. For the purpose of the analysis, the OPTN data, consisting of liver transplant candidates waitlisted in the United States, represent the population to which the results are directly applicable. Out of the data set, a cohort of liver transplant candidates newly waitlisted between 01/15/2016 and 12/31/2018 was created. The primary inclusion criteria for the analysis were (1) adults aged 18 years or older (2) registered for primary liver transplant with (3) end-stage liver disease. Patients listed for (1) multi-organ transplant, other than simultaneous liver-kidney transplant, those with (2) history of previous liver transplant, and those with (3) exception points at the time of registration, were excluded. These inclusion and exclusion criteria were consistent with prior iterations of the MELD score.

reMELD-Na: The retrospective cohort consisted of patients from the Eurotransplant database. Adult patients that were actively listed for a first liver transplantation between 1 january 2007 and 31 december 2018 were included in the cohort. Exclusion criteria were patients that received (non) standard exception ([N]SE) points, a high urgency (HU) status (i.e., UNOS status 1), living donor grafts, or multiorgan transplantations (other than kidney). 6944 patients were included in the study; 4860 patients were included in the trainingset and 2084 patients in the validation set.