About the MELD Score
The Model for End-Stage Liver Disease (MELD) score was originally developed to predict 3-month mortality after transjugular intrahepatic portosystemic shunting (TIPS) and was adopted by UNOS in 2002 to prioritize liver transplant allocation. It replaced the Child-Pugh score for organ allocation due to its objectivity — all variables are laboratory-based, eliminating subjective clinical assessments.
MELD Formula
MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43
Floor values: bilirubin, INR, and creatinine all floored at 1.0 mg/dL. Creatinine capped at 4.0 mg/dL (also set to 4.0 if dialysis ≥2× in past week). Score rounded to nearest integer.
MELD-Na Formula
MELD-Na = MELD + 1.32 × (137 − Na) − [0.033 × MELD × (137 − Na)]
Sodium is constrained to 125–137 mEq/L. MELD-Na capped at 40. Used by UNOS since 2016 for deceased donor liver allocation — it better captures mortality risk from hyponatremia in cirrhosis.
90-Day Mortality Estimates
| MELD Score | 90-Day Mortality | Clinical Context |
|---|---|---|
| <10 | ~1.9% | Compensated cirrhosis; outpatient management |
| 10–19 | ~6.0% | Moderate disease; close outpatient monitoring |
| 20–29 | ~19.6% | Decompensated; transplant evaluation warranted |
| 30–39 | ~52.6% | Severe; active transplant listing consideration |
| ≥40 | ~71.3% | Critical; high-urgency listing (Status 1A/1B criteria) |
Transplant Listing Threshold
UNOS data suggest that the survival benefit of liver transplantation begins to exceed the surgical mortality risk at a MELD ≥15. Below this threshold, the risk of transplant may outweigh the benefit in otherwise stable patients. Most transplant centers use MELD ≥15 as the threshold for active listing consideration.
Patients with hepatocellular carcinoma (HCC) meeting Milan criteria may receive MELD exception points to reflect their malignancy-related risk not captured by laboratory MELD.
References
Malinchoc M, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–871.
Kim WR, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018–1026.