MELD, MELD-Na, and MELD-XI in Heart Transplantation: Lessons From Liver Allocation Applied to Cardiac Recipients

All articles of this category (opens in new window) Background: The Model for End-Stage Liver Disease (MELD) score is the cornerstone of liver transplantation (LTX) allocation, predicting short-term mortality based on bilirubin, INR, and creatinine. In advanced heart failure, congestion induces hepatic and renal dysfunction, suggesting parallels to LTX. Modified scores (MELD-Na, MELD-XI) may improve applicability in heart transplantation (HTX). We analyzed MELD-based scores in a large single-center HTX cohort. Methods: We retrospectively reviewed 379 HTX recipients (2010–2025). MELD, MELD-Na, and MELD-XI were calculated from pretransplant laboratory values. Patients were stratified by MELD score ≤ 20 vs. >20. Posttransplant ECMO use and early complications were assessed. Results: MELD was calculable in 271 patients, MELD-Na in 183, and MELD-XI in 275 (72.6%), reflecting its practical applicability in anticoagulated patients. Median MELD was 15.3 [IQR: 10.9–19.5]; 22% had MELD > 20. High MELD (>20) patients had numerically higher ECMO use (34.4% vs. 33.0%) and complications (4.9% vs. 3.5%), but differences were not statistically significant ( p > 0.05). MELD-based scores nevertheless captured relevant hepatorenal dysfunction, with higher values reflecting more advanced comorbidity burden. Conclusion: MELD-based scores, established in liver allocation, are applicable in HTX and may help characterize hepatorenal dysfunction. In our cohort, MELD and MELD-Na did not significantly discriminate posttransplant ECMO use or early complications, whereas MELD-XI offered the broadest applicability due to frequent anticoagulation. While their prognostic impact appears limited, these scores may support comprehensive risk profiling in HTX candidates. Prospective multicenter studies are needed to clarify their role in patient selection and perioperative management. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany