Calculate MELD, MELD-Na, and MELD 3.0 scores for liver disease severity and transplant allocation. Estimates 3-month mortality and transplant priority.
The Model for End-Stage Liver Disease (MELD) score predicts 3-month mortality in patients with liver disease and serves as the primary organ allocation metric for liver transplantation in the United States. Originally developed to predict mortality after TIPS procedures, it was adopted by UNOS in 2002 for transplant allocation.
The MELD system has evolved through three versions: Original MELD (bilirubin, creatinine, INR), MELD-Na (adding sodium, adopted 2016), and MELD 3.0 (adding albumin and sex-based adjustment, adopted January 2024). Each iteration improved mortality prediction and reduced allocation disparities.
This calculator computes all three MELD versions simultaneously, allowing comparison and clinical decision support. The MELD-Na score is the current primary allocation score, though MELD 3.0 is the newest evidence-based version. Scores range from 6 to 40, with higher scores indicating greater disease severity and higher transplant priority. Check the example with realistic values before reporting. Use the steps shown to verify rounding and units. Cross-check this output using a known reference case.
MELD scoring is essential for liver transplant prioritization, determining when to list patients, and predicting short-term mortality in chronic liver disease. It guides clinical decisions about TIPS placement, surgical risk assessment in cirrhosis, and timing of transplant evaluation referral.
The three-version comparison in this calculator helps clinicians understand the impact of sodium and albumin on prognosis, and identify patients who may benefit from MELD exception points for conditions not well-captured by laboratory values alone.
MELD = 10 × [0.957 × ln(Cr) + 0.378 × ln(Bil) + 1.120 × ln(INR) + 0.643] MELD-Na = MELD − Na − 0.025 × MELD × (140 − Na) + 140 Sodium bounded 125-137 MELD 3.0 = 1.33(female) + 4.56×ln(Bil) + 0.82×(137−Na) − 0.24×(137−Na)×ln(Bil) + 9.09×ln(INR) + 11.14×ln(Cr) + 1.85×(3.5−Alb) − 1.83×(3.5−Alb)×ln(Cr) + 6 All scores bounded 6-40. Cr capped at 4.0; if dialysis ≥2x/week, Cr = 4.0.
Result: MELD 15, MELD-Na 15
A MELD-Na of 15 places the patient at the threshold where transplant listing evaluation is generally recommended. The 3-month mortality is approximately 6%. Serial monitoring every 1-3 months with reassessment for transplant if MELD rises above 20.
Before MELD (pre-2002), liver allocation was based on the Child-Pugh score and waiting time, leading to inefficient allocation and deaths on the waitlist. MELD transformed allocation to a severity-based system, reducing waitlist mortality. MELD-Na (2016) further improved fairness by penalizing hyponatremia. MELD 3.0 (2024) addresses the known female disadvantage — women had 10-15% higher waitlist mortality than men at the same MELD score.
Hepatocellular carcinoma patients receive exception MELD points because their tumor progression risk is not captured by lab values. Post-January 2024, HCC exception scoring uses a median MELD-at-transplant approach. Patients with polycystic liver disease, cholangiocarcinoma (after protocol), and metabolic conditions may also qualify for exceptions.
MELD predicts perioperative mortality in cirrhotic patients undergoing non-transplant surgery. MELD <10: low risk; 10-15: moderate risk; >15: high risk. An online tool (Mayo Surgical Risk Calculator) uses MELD plus ASA class and surgery type for more refined perioperative risk estimation.
Original MELD uses only bilirubin, creatinine, and INR. MELD-Na adds sodium (hyponatremia worsens prognosis in cirrhosis). MELD 3.0 (adopted January 2024) adds albumin and a female sex adjustment to address known disadvantages for women in prior MELD versions. Each iteration improved waitlist mortality prediction.
Creatinine is capped at 4.0 mg/dL and set to 4.0 for patients on dialysis because extremely high creatinine values disproportionately inflate the MELD score. The cap ensures that renal failure contributes meaningfully but does not overwhelm the other components of liver disease severity.
Certain conditions that cause significant morbidity/mortality but are not well-reflected by laboratory MELD receive "exception points" that augment the calculated MELD score. Common exceptions: hepatocellular carcinoma (HCC), hepatopulmonary syndrome, portopulmonary hypertension, and familial amyloid polyneuropathy. These are reviewed by regional UNOS boards.
AASLD guidelines recommend referral for transplant evaluation when MELD ≥15, as this is the threshold where transplant survival benefit exceeds waitlist survival. Patients with complications of portal hypertension (variceal bleeding, ascites, encephalopathy) should be referred regardless of MELD score.
UNOS requires MELD recertification based on the current score: MELD ≥25 every 7 days, MELD 19-24 every 30 days, MELD 11-18 every 90 days, MELD ≤10 every year. More frequent monitoring is appropriate during hospitalizations or acute decompensation.
MELD was designed for chronic liver disease. In acute liver failure (ALF), the Kings College Criteria or the Clichy criteria are more appropriate. ALF patients with acetaminophen toxicity may qualify for Status 1A listing (highest priority) independent of MELD score.