MELD / MELD-Na
Model for End-Stage Liver Disease — assesses severity of end-stage liver disease and prioritisation for liver transplantation.
Result
MELD
—
Original
MELD-Na
—
Current standard
MELD-Na Interpretation
| MELD-Na Score | 3-month mortality | Interpretation |
|---|---|---|
| < 10 | ≈ 1.9% | Low severity |
| 10 – 19 | ≈ 6% | Moderate severity |
| 20 – 29 | ≈ 19.6% | High severity |
| 30 – 39 | ≈ 52.6% | Very high severity |
| ≥ 40 | ≈ 71.3% | Extreme severity |
* Estimated mortality in patients on the liver transplant waiting list. MELD ranges: Kamath et al., 2001; MELD-Na validation: Kim et al., 2008.
Clinical Context
MELD (Model for End-Stage Liver Disease) was developed in 2001 to predict mortality in patients undergoing TIPS and was subsequently validated for stratification in liver transplant waitlists, replacing the Child-Pugh Score as the allocation criterion in the USA in 2002.
MELD-Na, which incorporates serum sodium, demonstrated superior predictive performance over the original MELD and was adopted as the official prioritisation score for liver transplant waitlists in the United States in 2016. Its use has since expanded to multiple countries and transplant systems internationally.
The MELD formula uses the natural logarithm of three parameters, with minimum values fixed at 1.0 to prevent negative results. Creatinine is capped at 4.0 mg/dL; patients on dialysis automatically receive this maximum value.
This calculator is complementary to Child-Pugh: while MELD relies entirely on objective laboratory parameters, Child-Pugh incorporates subjective clinical findings (ascites, encephalopathy). MELD has better accuracy for short-term mortality prediction in severe liver disease.
In the UK, NHS Blood and Transplant (NHSBT) uses UKELD (UK Model for End-Stage Liver Disease) — which also incorporates serum sodium — for transplant listing and allocation rather than MELD-Na; a minimum UKELD of 49 is generally required for listing. MELD/MELD-Na remain widely used internationally and for clinical severity assessment.
⚠ Limitations
- MELD does not predict well in acute alcoholic cirrhosis, severe alcoholic hepatitis, or hepatopulmonary syndrome — situations with their own prioritisation criteria.
- Patients with hepatocellular carcinoma (HCC) receive MELD exception points according to transplant programme criteria, which are not calculated by this tool.
- Creatinine may be falsely elevated in patients with fluid overload (cirrhotics with large-volume ascites), underestimating true renal function.
- MELD-Na may underestimate risk in women due to the tendency towards lower creatinine values — variants such as MELD 3.0 have been proposed to correct this bias.
- This calculator does not replace a complete clinical assessment or the decision of the transplant team.
References
- 1. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–470. PubMed ↗
- 2. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–1026. PubMed ↗
- 3. Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology. 2006;130(6):1652–1660. PubMed ↗