Mortality after cardiac transplant is predicted by The Model for End-Stage Liver Disease (MELD) score. The score is derived from serum bilirubin, creatinine and International Normalized Ratio (INR); abnormalities in each occurs with advanced liver disease. Given the hemodynamic burden experienced during cardiac transplant, we hypothesized that markers of milder pre-transplant liver dysfunction also predict early mortality after cardiac transplant.We conducted a retrospective cohort study of adult patients at our institution that underwent their first heart transplant from 2007 to 2012. We evaluated the utility of pre-transplant aspartate aminotransferase (AST), bilirubin, albumin, INR, platelets and imaging evidence of cirrhosis and splenomegaly in predicting 30-day mortality post transplant. We used univariable logistic regression to identify hepatic predictors of mortality post transplant. We then compared a risk score that integrated these predictors to the MELD score using receiver operating characteristic (ROC) curve analysis.The study population consisted of 126 heart transplant recipients (Age 49±13,male 66%,ischemic etiology 27%). Mortality rate was 10.3% at 30 days. Patients that died had more sternotomies, higher pre-transplant creatinine levels and were more likely to have congenital heart disease. Univariate hepatic predictors of 30-day post-operative mortality were pre-transplant: platelet count <150 000 (OR 3.5 [1.03-12.1]), above average spleen length (OR 4.1 [1.3-13.3]) and MELD score (OR 1.17 per 1-point increase [1.03-1.33]). AST, bilirubin, albumin, INR and imaging evidence of cirrhosis were not associated with 30-day mortality. Combining the MELD score with platelet count and spleen length into a single score improved the ROC from 0.70 to 0.79.In our cohort, pre-transplant spleen length and platelet count, parameters not included in the MELD score, predicted mortality post heart transplant. These markers of milder liver dysfunction enhanced the MELD score’s ability to predict early mortality after cardiac transplant.