Hepatic encephalopathy (HE) is a significant complication of cirrhosis and part of the CTP score. The UNOS database was queried for listings from February 2001 to February 2002 (CTP era) and February 2002 to February 2003 (MELD era). HE at listing, Grade III/IV HE at transplant, and 12-month posttransplant survival were compared. HE rate at listing was similar, whereas Grade III/IV HE at time of transplant was significantly lower in the MELD era. Waiting periods were shorter in the MELD era. Twelve-month posttransplant survival was lower in all patients with HE at listing (P < 0.0001) and for patients with Grade III/IV HE at transplant (P < 0.0001) in both eras. No significant change in posttransplant survival of HE patients was observed after MELD implementation. We conclude that (1) HE patients have worse posttransplant survival even after MELD; (2) MELD allows more rapid transplantation; and (3) rates of HE at listing have not changed since MELD implementation; however, rates of Grade III/IV HE at transplant have decreased.