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Impact of Model for End-Stage Liver Disease 3.0 on Waitlist Outcomes of Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis Among Liver Transplant Candidates.

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Title: Impact of Model for End-Stage Liver Disease 3.0 on Waitlist Outcomes of Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis Among Liver Transplant Candidates.
Authors: Lim WH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: whlim0403@gmail.com., Tan DJH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Mitra K; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Teng MLP; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore., Ng CH; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; Department of Digestive Disease Information and Research, School of Medicine, Kurume University, Fukuoka, Japan., Ko D; Department of Medicine, Bridgeport Hospital Yale New Haven Health, Bridgeport, Connecticut., Syn N; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Kow AW; Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore., Tung D; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore., Nakajima A; Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan., Sumida Y; Department of Internal Medicine, Division of Hepatology and Pancreatology, Aichi Medical University, Aichi, Japan; Department of Healthcare Management, International University of Health and Welfare, Tokyo, Japan., Takahashi H; Liver Center, Saga University Hospital, Saga, Japan., Tan EXX; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore., Noureddin M; Houston Methodist Hospital and Houston Research Institute, Houston, Texas., Chen VL; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan., Wijarnpreecha K; Department of Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine, Phoenix, Arizona; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Banner University Medical Center, Phoenix, Arizona; BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona., Huang DQ; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore., Bui AT; Department of Statistical Sciences and Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia., Muthiah M; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore., Siddiqui MS; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia. Electronic address: mohammad.siddiqui@vcuhealth.org.
Source: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2026 Aug; Vol. 24 (8), pp. 2181-2190. Date of Electronic Publication: 2025 Oct 25.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: W.B. Saunders for the American Gastroenterological Association Country of Publication: United States NLM ID: 101160775 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1542-7714 (Electronic) Linking ISSN: 15423565 NLM ISO Abbreviation: Clin Gastroenterol Hepatol Subsets: MEDLINE
Imprint Name(s): Original Publication: Philadelphia, PA : W.B. Saunders for the American Gastroenterological Association, 2003-
MeSH Terms: Waiting Lists*/mortality , Liver Transplantation*/statistics & numerical data , Liver Cirrhosis*/surgery , Liver Cirrhosis*/mortality , End Stage Liver Disease*/surgery , End Stage Liver Disease*/mortality , Fatty Liver*/complications, Humans ; Female ; Retrospective Studies ; Middle Aged ; Male ; Adult ; Severity of Illness Index ; Aged ; Registries
Abstract: Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is rapidly growing as an indication for liver transplantation (LT). However, the impact of Model for End-stage Liver Disease (MELD) 3.0 on waitlist outcomes in this population is not established. This study assessed the impact of MELD 3.0 on waitlist outcomes of patients with MASH cirrhosis using the Scientific Registry of Transplant Recipients database.
Methods: This was a retrospective analysis of the Scientific Registry of Transplant Recipients/United Network for Organ Sharing database including LT waitlist registrants from January 1, 2016, to December 31, 2022. Primary outcomes were 90-day waitlist mortality and transplantation probability in patients with MASH vs non-MASH cirrhosis.
Results: Among 44,037 waitlist registrants, 12,790 had MASH cirrhosis and 31,247 had non-MASH cirrhosis. The median follow-up was 2.63 months. In MASH cirrhosis, 65.4% were up-categorized and 11.2% were down-categorized when transitioning from MELD-Na to MELD 3.0. Up-categorization was associated with higher 90-day waitlist mortality (hazard ratio, 1.14; 95% confidence interval, 1.05-1.24; P = .002) but not higher transplantation probability (hazard ratio, 1.04; 95% confidence interval, 0.98-1.09; P = .18). Among female patients with MASH cirrhosis, up-categorization similarly did not translate into improved transplant probability.
Conclusions: Although MELD 3.0 reclassifies a substantial proportion of patients with MASH-particularly women-it does not appear to increase transplant access despite higher predicted mortality risk. These findings highlight residual gaps in how MELD 3.0 captures clinical risk in MASH cirrhosis and underscore the need for prospective data following its implementation.
(Copyright © 2025 American Gastroenterological Association Institute. Published by Elsevier Inc. All rights reserved.)
Contributed Indexing: Keywords: Cirrhosis; Liver Transplantation; Model for End-Stage Liver Disease (MELD) Score; Nonalcoholic Steatohepatitis; Waitlist Mortality
Entry Date(s): Date Created: 20251124 Date Completed: 20260722 Latest Revision: 20260722
Update Code: 20260723
DOI: 10.1016/j.cgh.2025.10.016
PMID: 41284513
Database: MEDLINE
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  Data: Impact of Model for End-Stage Liver Disease 3.0 on Waitlist Outcomes of Metabolic Dysfunction-Associated Steatohepatitis Cirrhosis Among Liver Transplant Candidates.
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  Data: <searchLink fieldCode="AU" term="%22Lim+WH%22">Lim WH</searchLink>; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: whlim0403@gmail.com.<br /><searchLink fieldCode="AU" term="%22Tan+DJH%22">Tan DJH</searchLink>; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Mitra+K%22">Mitra K</searchLink>; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Teng+MLP%22">Teng MLP</searchLink>; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Ng+CH%22">Ng CH</searchLink>; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; Department of Digestive Disease Information and Research, School of Medicine, Kurume University, Fukuoka, Japan.<br /><searchLink fieldCode="AU" term="%22Ko+D%22">Ko D</searchLink>; Department of Medicine, Bridgeport Hospital Yale New Haven Health, Bridgeport, Connecticut.<br /><searchLink fieldCode="AU" term="%22Syn+N%22">Syn N</searchLink>; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Kow+AW%22">Kow AW</searchLink>; Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Tung+D%22">Tung D</searchLink>; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Nakajima+A%22">Nakajima A</searchLink>; Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.<br /><searchLink fieldCode="AU" term="%22Sumida+Y%22">Sumida Y</searchLink>; Department of Internal Medicine, Division of Hepatology and Pancreatology, Aichi Medical University, Aichi, Japan; Department of Healthcare Management, International University of Health and Welfare, Tokyo, Japan.<br /><searchLink fieldCode="AU" term="%22Takahashi+H%22">Takahashi H</searchLink>; Liver Center, Saga University Hospital, Saga, Japan.<br /><searchLink fieldCode="AU" term="%22Tan+EXX%22">Tan EXX</searchLink>; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.<br /><searchLink fieldCode="AU" term="%22Noureddin+M%22">Noureddin M</searchLink>; Houston Methodist Hospital and Houston Research Institute, Houston, Texas.<br /><searchLink fieldCode="AU" term="%22Chen+VL%22">Chen VL</searchLink>; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.<br /><searchLink fieldCode="AU" term="%22Wijarnpreecha+K%22">Wijarnpreecha K</searchLink>; Department of Medicine, Division of Gastroenterology and Hepatology, University of Arizona College of Medicine, Phoenix, Arizona; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Banner University Medical Center, Phoenix, Arizona; BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.<br /><searchLink fieldCode="AU" term="%22Huang+DQ%22">Huang DQ</searchLink>; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Bui+AT%22">Bui AT</searchLink>; Department of Statistical Sciences and Operations Research, Virginia Commonwealth University (VCU), Richmond, Virginia.<br /><searchLink fieldCode="AU" term="%22Muthiah+M%22">Muthiah M</searchLink>; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.<br /><searchLink fieldCode="AU" term="%22Siddiqui+MS%22">Siddiqui MS</searchLink>; Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia; Hume-Lee Transplant Center, Virginia Commonwealth University Health System, Richmond, Virginia. Electronic address: mohammad.siddiqui@vcuhealth.org.
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  Data: Background & Aims: Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is rapidly growing as an indication for liver transplantation (LT). However, the impact of Model for End-stage Liver Disease (MELD) 3.0 on waitlist outcomes in this population is not established. This study assessed the impact of MELD 3.0 on waitlist outcomes of patients with MASH cirrhosis using the Scientific Registry of Transplant Recipients database.<br />Methods: This was a retrospective analysis of the Scientific Registry of Transplant Recipients/United Network for Organ Sharing database including LT waitlist registrants from January 1, 2016, to December 31, 2022. Primary outcomes were 90-day waitlist mortality and transplantation probability in patients with MASH vs non-MASH cirrhosis.<br />Results: Among 44,037 waitlist registrants, 12,790 had MASH cirrhosis and 31,247 had non-MASH cirrhosis. The median follow-up was 2.63 months. In MASH cirrhosis, 65.4% were up-categorized and 11.2% were down-categorized when transitioning from MELD-Na to MELD 3.0. Up-categorization was associated with higher 90-day waitlist mortality (hazard ratio, 1.14; 95% confidence interval, 1.05-1.24; P = .002) but not higher transplantation probability (hazard ratio, 1.04; 95% confidence interval, 0.98-1.09; P = .18). Among female patients with MASH cirrhosis, up-categorization similarly did not translate into improved transplant probability.<br />Conclusions: Although MELD 3.0 reclassifies a substantial proportion of patients with MASH-particularly women-it does not appear to increase transplant access despite higher predicted mortality risk. These findings highlight residual gaps in how MELD 3.0 captures clinical risk in MASH cirrhosis and underscore the need for prospective data following its implementation.<br /> (Copyright © 2025 American Gastroenterological Association Institute. Published by Elsevier Inc. All rights reserved.)
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  Data: <i>Keywords: </i>Cirrhosis; Liver Transplantation; Model for End-Stage Liver Disease (MELD) Score; Nonalcoholic Steatohepatitis; Waitlist Mortality
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        Text: English
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        Type: general
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