Objectives: Under the present liver transplant policy, patients with the highest risk of death receive preference for organ placement. The aim of this study was to evaluate the Model for End-stage Liver Disease (MELD) and seven prognostic derivatives of this test for outcome prediction in cirrhotic patients on liver transplant wait lists.

Material and methods: The study included 416 patients (65.9% male; age 49 ± 13.9 years) who were entered to liver transplant wait lists from January 2013 to October 2016. Study endpoints were 3-month, 6-month, and 1-year mortality.

Results: All prognostic models had acceptable overall performances (0.12 < Brier score < 0.21). The MELD-to-serum sodium ratio test outperformed its counterparts at all 3 endpoints. Estimated C statistics ranged from 0.77 to 0.83. The largest value at 3 months was for the 5-variable MELD score (0.83), and the largest value at 6 months (0.82) and 1 year (0.83) was for the MELD-albumin score. The Hosmer-Lemeshow goodness-of-fit test and calibration plots revealed underestimation for the entire range of predicted risk (P < .001). With decision curve analysis, the MELD-to-serum sodium ratio and United Kingdom Model for End-Stage Liver Disease scoring tests covered the most extensive range of optimal threshold probabilities.

Conclusions: Although some derivations, including sodium and albumin, showed effective prioritization of liver transplant candidates, poor calibration statistics highlighted the need for a recalibration process as an inevitable prerequisite before daily clinical use of these tests at the individual level.