In its latest iteration, the MELD 3.0 improves the prediction of waitlist mortality by the additions of female sex and serum albumin level as variables, including bilirubin by sodium and albumin by creatinine interactions, and setting a new upper limit for creatinine at 3.0 mg/dL.4 Nevertheless, there are clinical scenarios where the MELD score may not be as reflective of mortality in cirrhosis (eg, compensated cirrhosis with chronic kidney disease15 or patients with low MELD scores who have liver-related complications, otherwise known as “sicker than MELD” patients16). This evidence concerns the gene ALB and Cirrhosis.