MELD

Overview

MELD was originally developed to predict 90-day mortality after transjugular intrahepatic portosystemic shunt (TIPS) placement. In 2002 it was adopted by UNOS/OPTN as the primary algorithm for prioritising liver transplant allocation in the United States, replacing the Child-Pugh score. It has since been adopted internationally. Scores are clamped between 6 and 40.

Formula

MELD = 3.78 × ln(Bilirubin) + 11.2 × ln(INR) + 9.57 × ln(Creatinine) + 6.43

All values in mg/dL. Result rounded to nearest integer, clamped 6–40.

Clamping Rules

Variable	Floor	Cap	Special
Bilirubin	1.0 mg/dL	—	—
INR	1.0	—	—
Creatinine	1.0 mg/dL	4.0 mg/dL	Set to 4.0 if on dialysis twice/week in past 7 days
MELD total	6	40	—

Score Interpretation

MELD Score	Severity	Approx. 90-day Mortality
6–9	Mild	~1.9 %
10–19	Moderate	~6–20 %
20–29	Severe	~20–76 %
30–39	Very severe	~52–83 %
≥ 40	End-stage	> 71 %

Clinical Use

• Liver transplant waitlist prioritisation (UNOS/OPTN, Eurotransplant)
• Prognosis in acute-on-chronic liver failure (ACLF), hepatocellular carcinoma, and cirrhosis
• Pre-TIPS patient selection and post-procedure outcome prediction
• Risk stratification in spontaneous bacterial peritonitis (SBP)

Notes on MELD-Na

MELD-Na (MELD-Sodium) incorporates serum sodium to account for the additional mortality risk in hyponatraemic patients with cirrhosis. Formula: MELD-Na = MELD + 1.32 × (137 − Na) − 0.24 × (MELD × (137 − Na)). It has been the standard UNOS allocation algorithm since 2016 and generally provides modestly better discrimination than MELD alone.

Literature

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.