biostudies-literatureRodriguez-Peralvarez MLGeneralitat de CatalunyaConsejería de Salud y Consumo, Junta de AndalucíaInstituto de Salud Carlos IIIMinisterio de Ciencia y Tecnología, Gobierno de EspañaConsejería de Transformación Económica, Industria, Conocimiento y Universidadese70520https://www.ebi.ac.uk/biostudies/studies/S-EPMC12853322biostudies-literatureUnknown46(3)<h4>Background and aims</h4>Although GEMA-Na outperforms MELD 3.0 for liver allocation, concerns about the subjectivity of its ascites component persist. We compared the performance of a GEMA-Na iteration that excludes ascites with other allocation scores.<h4>Approach and results</h4>A multinational cohort study was conducted, including adult candidates for elective liver transplantation in the UK (2010-2020), Australia (1998-2020), and Spain (2016-2021). The primary outcome was mortality or delisting for sickness within 90 days. The prognostic impact of ascites was evaluated using multivariable Cox's regression. Discrimination was assessed using Harrell's c-statistics (Hc). The study included 15 391 patients (28.5% women). The prevalence of the primary outcome was 5.8% in the UK, 5.3% in Liver international : official journal of the International Association for the Study of the LiverExcluding Ascites From the GEMA-Na Score Does Not Impact Outcome Predictions in Liver Transplant Candidates.PMC12853322PI22/003122021-SGR-01331PID2023-150663NB-C22PREDOC-00489PI25/00439Cachero AMajumdar AGastaca MMolina Perez ECepeda-Franco CKalafateli MRodriguez-Soler MGuijo-Rubio DOrtiz MLTaylor RRodriguez-Peralvarez MLColmenero JMartin Mateos RCuadrado Lavin AGomez-Orellana AMOtero ABlanco Fernandez GGonzalez Grande RRomero MDopazo CArias Milla ATsochatzis EEspinosa MDAguilera MVBarreales MLorente SOton EGonzalez Dieguez LMcCaughan GWSogbe MHervas Martinez CAlonso Martin Cde la Rosa GfalseExcluding Ascites From the GEMA-Na Score Does Not Impact Outcome Predictions in Liver Transplant Candidates.<h4>Background and aims</h4>Although GEMA-Na outperforms MELD 3.0 for liver allocation, concerns about the subjectivity of its ascites component persist. We compared the performance of a GEMA-Na iteration that excludes ascites with other allocation scores.<h4>Approach and results</h4>A multinational cohort study was conducted, including adult candidates for elective liver transplantation in the UK (2010-2020), Australia (1998-2020), and Spain (2016-2021). The primary outcome was mortality or delisting for sickness within 90 days. The prognostic impact of ascites was evaluated using multivariable Cox's regression. Discrimination was assessed using Harrell's c-statistics (Hc). The study included 15 391 patients (28.5% women). The prevalence of the primary outcome was 5.8% in the UK, 5.3% in 2026-01-01T00:00:00Z2026 Mar2026-06-13T05:28:10.386Z2026-06-13T03:09:18.661ZS-EPMC128533224160888310.1111/liv.70520