Does MELD Over-Prioritize Alcohol-Associated Hepatitis for Liver Transplantation?: Liver Transplantation | September 2026

What Did the Study Find?

Using US national UNOS data from 2018–2024, investigators compared transplant candidates with alcohol-associated hepatitis (AAH), other alcohol-associated liver disease (ALD), and non-ALD indications.

• Waitlisting and transplantation for AAH increased more than six-fold, with 98.2% of transplant centers performing LT for this indication.
• Patients with AAH had lower waitlist mortality: 8.2% vs 12.6% for other ALD and 19.3% for non-ALD.
• Yet AAH patients had the highest transplant rate: 81.2% vs 69.0% and 67.0%, respectively.
• After adjustment, waitlist mortality remained higher for both other ALD (aHR 1.23) and non-ALD (aHR 1.86) compared with AAH.
• In AAH, MELD scores below 40 were not significantly associated with waitlist mortality.
• Serum sodium, an important MELD component, did not predict AAH waitlist mortality.
• Conversely, INR was a substantially stronger mortality predictor in AAH than in other transplant indications.

Why Does It Matter?

MELD-based allocation assumes that a given score represents broadly comparable short-term mortality risk across liver diseases. These data suggest that this assumption may not hold equally for AAH, potentially affecting how scarce donor organs are prioritized.

GastroAGI Takeaway

MELD may not calibrate waitlist mortality equally across transplant indications. Patients listed with AAH experienced lower waitlist mortality yet substantially higher transplantation rates, raising an important allocation-equity question. This study supports re-evaluating how MELD components predict mortality in AAH, but as an observational registry analysis, it does not by itself establish what the replacement allocation strategy should be.