MELD Score Calculator — Liver Disease Severity & Transplant Priority

How to Use This Calculator

1. Enter bilirubin (mg/dL), creatinine (mg/dL), and INR from the most recent labs.
2. If patient is on dialysis ≥2×/week, select "Yes" to cap creatinine at 4.0.
3. MELD score and 3-month mortality display instantly.
4. Use the MELD 3.0 tab for the updated sex-inclusive formula.
5. Use the Mortality Bands tab for transplant priority context.

Formula

Example

Frequently Asked Questions

• What is the MELD score? ▼
  The Model for End-Stage Liver Disease (MELD) score is a validated numerical scale used to estimate the severity of chronic liver disease and the probability of short-term mortality without liver transplantation. Originally developed by Kamath et al. at the Mayo Clinic and published in Hepatology in 2001, MELD was initially created to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) procedures but was subsequently validated as a predictor of 90-day mortality across the full spectrum of liver disease aetiologies. The formula uses three laboratory values: serum creatinine (reflecting renal function, which is profoundly affected by portal hypertension and hepatorenal syndrome), total bilirubin (reflecting hepatic synthetic and excretory function), and the International Normalised Ratio (INR, reflecting hepatic coagulation factor synthesis). Each variable is log-transformed and weighted: MELD = 9.57 × ln(creatinine) + 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 6.43. Scores range from approximately 6 to 40; higher scores indicate more severe disease and higher mortality. MELD replaced the Child-Pugh score for liver transplant allocation in the United States in 2002.
• How is MELD used in liver transplant allocation? ▼
  Since February 2002, UNOS (United Network for Organ Sharing) and OPTN (Organ Procurement and Transplantation Network) have used MELD score as the primary determinant of liver transplant allocation priority in the United States. The rationale is that organs should go to the sickest patients who will benefit most — those with the highest waitlist mortality. Under MELD-based allocation, candidates are ranked within ABO blood type and geographic zones (transplant service areas and UNOS regions) primarily by MELD score, with the highest-score patients receiving priority. Patients are listed when their MELD score reaches a threshold where transplant benefit (post-transplant survival gain) exceeds waitlist mortality risk — generally considered to be MELD ≥15. Patients with MELD below 15 have lower waitlist mortality than 1-year post-transplant mortality, meaning transplant may not improve their outcomes. Exception points are granted for specific conditions not well captured by MELD, most importantly hepatocellular carcinoma (HCC) within Milan criteria and hepatopulmonary syndrome, where the MELD score underestimates true mortality risk.
• What is MELD 3.0 and how does it differ from standard MELD? ▼
  MELD 3.0 is an updated version of the MELD formula published by Kim WR et al. in Hepatology in 2021, developed specifically to address the sex-based disparity in liver transplant access identified under the original MELD formula. Studies showed that women were consistently waitlisted at higher MELD scores than men and had higher waitlist mortality at equivalent MELD scores — a gap attributed to biological differences in muscle mass (women have lower creatinine production per unit of renal function) and differences in albumin metabolism. MELD 3.0 incorporates three additional variables: serum albumin (to capture nutritional/synthetic function not fully reflected by INR), serum sodium (already used in MELD-Na but incorporated directly into the regression), and a female sex variable (+1.33 points). The formula is: MELD 3.0 = 4.56 × ln(bilirubin) + 0.82 × (137−Na) − 0.24 × (137−Na) × ln(creatinine) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5−albumin) − 1.83 × (3.5−albumin) × ln(creatinine) + 1.33 (if female) + 7. MELD 3.0 was implemented by UNOS in 2022.
• When does dialysis affect MELD calculation? ▼
  Dialysis affects MELD calculation through a specific adjustment rule: if a patient has undergone renal replacement therapy (haemodialysis or continuous renal replacement therapy) at least twice in the prior week, the creatinine value is automatically set to 4.0 mg/dL regardless of the measured serum creatinine. This adjustment exists because patients on dialysis may have a lower measured serum creatinine due to dialytic clearance, which would artificially underestimate their true degree of renal failure and produce a falsely low MELD score. Setting creatinine to 4.0 (the maximum cap in the MELD formula) ensures that dialysis-dependent patients receive the highest creatinine-derived MELD points, accurately reflecting their severely impaired renal function. In general, the MELD formula applies both a floor (creatinine minimum 1.0 mg/dL) and a ceiling (maximum 4.0 mg/dL) to all three variables to prevent mathematical artefact from extreme values — all variables are floored at 1.0 to avoid negative logarithms and capped to limit score inflation from outlier values.
• What MELD score qualifies for liver transplant listing? ▼
  There is no single fixed MELD threshold that automatically qualifies a patient for transplant listing — the decision involves clinical judgment, etiology, trajectory, and centre-specific criteria. However, widely applied principles guide listing decisions. A MELD score of 15 or above is generally considered the threshold at which transplant benefit exceeds risk: at MELD <15, waitlist mortality is lower than 1-year post-transplant mortality, meaning transplant may not extend life. At MELD ≥15, transplant survival advantage increases with rising score. Most US transplant centres initiate evaluation at MELD 10–12 to allow time for workup, as the evaluation process takes weeks to months. At MELD ≥25–30, transplant is increasingly urgent. Status 1A and 1B designations (acute liver failure, primary non-function of a transplanted liver) override MELD completely and receive the highest allocation priority. In practice, MELD trajectories matter as much as absolute values: a patient with MELD rising from 12 to 20 over 3 months has a different prognosis than one with a stable MELD of 20. Serial measurements every 1–12 months depending on severity are recommended.

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