MELD Score Calculator
The Model for End-Stage Liver Disease (MELD) score predicts mortality in liver disease and determines liver transplant priority. Enter lab values to calculate MELD and estimate survival.
Understanding the MELD Score
The MELD score was developed in 2001 to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) procedures. It quickly became the standard tool for liver transplant allocation in the United States, replacing the older Child-Pugh score.
MELD uses three objective lab values: serum creatinine (kidney function), total bilirubin (liver's ability to clear bile), and INR (liver's ability to produce clotting factors). The formula is: MELD = 3.78×ln(bilirubin) + 11.2×ln(INR) + 9.57×ln(creatinine) + 6.43.
Scores range from 6 to 40. A MELD of 10 carries ~2% 3-month mortality, MELD 20 carries ~20%, and MELD 30 carries ~50% mortality without transplant. The score is updated every few months as labs change, ensuring allocation reflects current illness severity.
Medical disclaimer: This calculator is for educational purposes only. MELD score calculation for transplant listing must be performed by a qualified hepatologist or transplant team. Liver transplant decisions involve complex medical and ethical considerations beyond MELD alone.
MELD and Liver Transplant Allocation
Before MELD, transplant waiting lists used time on the list as the main allocation factor. Sicker patients often died waiting while healthier patients received organs simply because they joined the list earlier. MELD revolutionized this by prioritizing medical urgency.
Today, when a donor liver becomes available, it's offered to the patient with the highest MELD score in the same geographic region and compatible blood type. Exceptions exist for hepatocellular carcinoma (HCC), which receives additional points, and for acute fulminant liver failure, which bypasses MELD entirely.
MELD ≥15 generally meets criteria for transplant listing, as mortality risk begins to exceed surgical risk. MELD ≥20 is considered high priority. MELD ≥30 patients are critically ill and may be listed as Status 1A if they develop acute liver failure complications.
MELD-Na (MELD-Sodium) is a newer version incorporating serum sodium, which predicts mortality better in patients with ascites and hepatorenal syndrome. MELD-Na is now the standard allocation score in the US as of 2016.
Clinical Interpretation and Limitations
MELD predicts short-term mortality but doesn't capture all aspects of liver disease severity. It underestimates mortality in patients with hepatic encephalopathy, recurrent variceal bleeding, or refractory ascites but relatively preserved lab values.
Certain conditions receive MELD exception points. Hepatocellular carcinoma within Milan criteria (single tumor ≤5 cm or up to 3 tumors ≤3 cm each) gets additional points because tumor progression, not lab values, determines urgency. Hepatopulmonary syndrome and portopulmonary hypertension also qualify for exceptions.
MELD doesn't account for quality of life. A patient with MELD 12 and debilitating hepatic encephalopathy may suffer more than a patient with MELD 18 but minimal symptoms. Transplant teams weigh MELD alongside functional status and comorbidities.
Limitations include dialysis dependency (creatinine is capped), anticoagulation therapy (INR artificially elevated), and NASH cirrhosis with preserved synthetic function. Despite these limitations, MELD remains the most objective and widely validated tool for predicting liver disease mortality.
Frequently Asked Questions
What is the MELD score?
The MELD score uses creatinine, bilirubin, and INR to predict 3-month mortality in end-stage liver disease. Scores range from 6 to 40. Higher scores indicate worse prognosis and higher transplant priority.
How is MELD used for transplant allocation?
In the US, liver transplants are allocated based on MELD score, not waiting time. Patients with higher MELD scores (sicker patients) receive organs first. MELD ≥15 typically warrants transplant listing.
What is a good MELD score?
MELD <10 is mild liver disease with low short-term mortality (~2%). MELD 10-19 is moderate disease. MELD 20-29 is severe. MELD ≥30 indicates very high mortality (>50% at 3 months without transplant).
Why is creatinine capped at 4.0?
Creatinine values above 4.0 mg/dL are set to 4.0 to prevent MELD from being driven primarily by kidney failure. Patients on dialysis automatically get creatinine = 4.0.
What conditions increase MELD?
Cirrhosis from any cause (alcohol, hepatitis B/C, NASH, autoimmune hepatitis) increases MELD as liver function declines. Acute liver failure, hepatorenal syndrome, and spontaneous bacterial peritonitis rapidly elevate MELD.