OPTN/SRTR Post-Liver Transplant Survival Prediction
Recipient Factors
years
Current calculated MELD
g/dL
kg/m²
SOFT Score
Predict post-liver-transplant survival based on recipient characteristics.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
To predict 3-month post-liver-transplant survival based on recipient factors
To inform transplant candidate selection and listing decisions
To complement MELD score for transplant benefit assessment
To support pre-transplant counselling about expected outcomes
To benchmark centre-level risk-adjusted outcomes
Patient Population
Derived from the OPTN/SRTR database including all adult liver transplant recipients in the United States (n = 21,507 from 2002-2006). The score has been validated in multiple independent cohorts including a UK cohort and the European Liver Transplant Registry.
How it Works
Scoring Components
01
Age > 60 years (3 points): Older age independently predicts post-transplant mortality.
02
MELD > 20 (2 points) / MELD > 30 (5 points): Disease severity is the dominant recipient risk factor.
03
Albumin < 2.5 g/dL (2 points): Reflects nutritional status and hepatic synthetic function.
04
Ascites (2 points): Signifies portal hypertension and disease severity.
05
Encephalopathy (2 points): Hepatic encephalopathy is a marker of advanced liver disease.
06
Prior Abdominal Surgery (2 points): Increases technical complexity and operative risk.
07
Life Support (6 points): Pre-transplant ICU dependency with ventilator or inotropes.
08
Portal Bleed (5 points): Recent variceal bleed is a marker of acute decompensation.
09
Dialysis (3 points): Renal failure requiring dialysis strongly predicts post-transplant mortality.
10
BMI > 35 (2 points): Obesity is associated with increased surgical and metabolic complications.
11
Previous Transplant (3 points): Retransplantation carries higher immunologic and technical risk.
Clinical Pearls
SOFT vs. BAR Score
The SOFT score uses only recipient variables, unlike the BAR score which incorporates both donor and recipient factors. SOFT is best suited for candidate selection (i.e., "Is this patient likely to survive transplant?"), while BAR is better for donor-recipient matching ("Does this donor-recipient pair have acceptable risk?"). The two scores can be used sequentially.
SOFT Score Thresholds
SOFT 0-5: Low risk — 3-month mortality < 5%
SOFT 6-10: Moderate risk — 5-10%
SOFT 11-18: High risk — 10-25%
SOFT 19-25: Very high risk — 25-50%
SOFT > 25: Prohibitive — > 50% 3-month mortality
Scores should be interpreted in the context of waitlist mortality risk. A high SOFT score may still be acceptable for a patient with very high waitlist mortality (MELD > 35).
Next Steps
Clinical Action by Score Tier
01
SOFT < 10: Proceed with standard transplant evaluation and listing.
02
SOFT 10-18: Discuss risk openly. Consider preoperative optimisation (nutrition, physical therapy, dental clearance).
03
SOFT 19-25: Multidisciplinary review required. Consider reducing MELD through bridging therapies (TIPS, liver support).
04
SOFT > 25: Transplant may not offer survival benefit. Consider alternative strategies or re-evaluation after optimisation.
The Evidence
Original Derivation
Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation.
Rana A et al. • Am J Transplant.. 2008;8(12):2537–2546. n = 21,507. C-statistic 0.73 for 3-month mortality.
View SourceOrigins & History
Development
The SOFT score was developed by Dr. Abbas Rana and colleagues at Columbia University and the University of Texas Southwestern Medical Center. It was one of the first recipient-only risk scoring systems for liver transplantation designed for routine clinical use at the bedside.
Last Comprehensive Review: 2026-07-17