Objective To investigate the association of Model for End- Stage Liver Disease( MELD) score with complications and early survival rate after liver transplantation for benign end- stage liver disease,and to analyze the criteria to select donor livers with fatty liver for patients with different MELD scores. Methods A total of 145 recipients of orthotopic liver transplantation with benign end- stage liver disease in Fuzhou General Hospital of Nanjing Military Command from January 2008 to December 2013 were analyzed retrospectively,and frozen fatty liver biopsy was performed for donor livers in 47 patients before transplantation. The patients were divided into the following three groups according to MELD score: group A with 28 patients( MELD score ≥30,mean MELD score 35. 7 ± 5. 5); group B with 35 patients( 20≤ MELD score<30,mean MELD score 22. 5 ±2. 3); group C with 82 patients( MELD score <20,mean MELD score 11. 0 ±3. 7). The preoperative,intraoperative,and postoperative biochemical parameters,postoperative complications,and survival rate were compared between these groups. The 47 patients receiving frozen biopsy were divided into the following two groups according to MELD score: group a with 9 patients( MELD score ≥30); group b with 38 patients( MELD score < 30). The 1- year survival rates of the recipients of donor livers with mild,moderate,and severe fatty liver were compared between the two groups. Comparison of continuous data between the two groups was made by t test or ANOVA and comparison of categorical date was made by chi- square test or Fisher's exact. Results The 1- month survival rate after transplantation showed no significant difference between groups A,B,and C( 71. 4%,87. 8%,and 86. 6%,respectively; P >0. 05); group A had significantly lower 3- month,6- month,and 1- year survival rates than groups B and C( 64. 3% /64. 3% /64. 3% vs 88. 6% /88. 6% /88. 6% and 87. 8% /86. 6% /86. 6%,all P < 0. 05). Group A had a significantly higher incidence of postoperative complications than groups B and C( 82. 14% vs 42. 86% and 25. 61%,P < 0. 05). As for the patients receiving donor livers with moderate and severe fatty liver,group a had a significantly lower 1- year survival rate than group b( 20. 0% vs 81. 8%; χ2= 5. 111,P = 0. 014). Conclusion The recipients with a high MELD score( ≥30) may experience a large number of postoperative complications and a high mortality rate,and therefore donor livers with moderate and severe fatty liver should be abandoned.