{ "id": "eppknzh9mr", "slug": "model-for-end-stage-liver-disease-score", "title": "Model for End-stage Liver Disease score", "updated": "2026-10-15", "topic_path": [ { "id": "life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/topics/life" }, { "id": "life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health" }, { "id": "life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical" }, { "id": "life.health.clinical.clinical-transplantation", "label": "Organ and tissue transplantation", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-transplantation" }, { "id": "life.health.clinical.clinical-transplantation.alpha-li-to-x", "label": "Titles Li to X", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-transplantation.alpha-li-to-x" } ], "geo": [ { "id": "geo.us.t1946.life.health.clinical.clinical-transplantation", "label": "United States · 1946 to 2000: Organ and tissue transplantation", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us.t1946.life.health.clinical.clinical-transplantation", "path": [ { "id": "geo.us", "label": "United States", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us" }, { "id": "geo.us.t1946", "label": "United States · 1946 to 2000", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us.t1946" }, { "id": "geo.us.t1946.life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us.t1946.life" }, { "id": "geo.us.t1946.life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us.t1946.life.health" }, { "id": "geo.us.t1946.life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us.t1946.life.health.clinical" }, { "id": "geo.us.t1946.life.health.clinical.clinical-transplantation", "label": "Organ and tissue transplantation", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.us.t1946.life.health.clinical.clinical-transplantation" } ] } ], "excerpt": "The Model for End-stage Liver Disease (MELD) score predicts three-month mortality in chronic liver disease from three blood tests, and has prioritized US liver transplant candidates since 2002.", "snippet": "The Model for End-stage Liver Disease (MELD) score predicts three-month mortality in chronic liver disease from three blood tests, and has prioritized US liver transplant candidates since 2002.", "node": "life.health.clinical.clinical-transplantation.alpha-li-to-x", "markdown": "# Model for End-stage Liver Disease score\n\nThe Model for End-stage Liver Disease (MELD) score is a prognostic scoring system that estimates three-month mortality in chronic liver disease from three laboratory values: serum bilirubin, serum creatinine, and the international normalized ratio (INR) for prothrombin time.[1](https://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld/print) The United Network for Organ Sharing (UNOS) adopted it in 2002 to prioritize liver transplant candidates in the United States, replacing a system in which waiting time and clinical judgment dominated.[1](https://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld/print) The score ranges from 6 to 40, and higher scores indicate more urgent need for transplantation within the next three months.[2](https://www.mayoclinic.org/tests-procedures/meld-score-liver-disease/about/pac-20590545)\n\n| Key fact | Detail |\n|---|---|\n| What it predicts | Three-month mortality in chronic liver disease, from objective laboratory values[1](https://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld/print) |\n| Inputs (original) | Serum bilirubin, serum creatinine, INR; the first version also included etiology of liver disease[3](https://medschool.cuanschutz.edu/docs/librariesprovider60/education-docs/heartbeat-im-res/suggested-read/kamath-ps--meld-score-development-2001.pdf?sfvrsn=a35431b9_2) |\n| Score range | 6 to 40, with creatinine capped at 4 mg/dl and each component floored at 1[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) |\n| Mortality gradient | Waitlist 3-month mortality of 1.9% at MELD <9 versus 71.3% at MELD ≥40[5](https://pubmed.ncbi.nlm.nih.gov/12512033/) |\n| US adoption | Approved by UNOS on February 27, 2002[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) |\n| Current US formula | MELD 3.0, implemented July 15, 2023, to more accurately characterize end-stage liver disease severity across the sexes[6](https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2026.1755115/full) |\n| Discrimination | c-statistic 0.83 for waitlist mortality versus 0.76 for Child-Turcotte-Pugh[5](https://pubmed.ncbi.nlm.nih.gov/12512033/) |\n\n## How it works\n\nMELD is a log-linear risk model. Each laboratory value enters as its natural logarithm, which lessens the influence of extreme values, and the weighted terms are summed.[7](https://www.e-cmh.org/journal/view.php?number=1015) Because the logarithm is monotonic, any worsening in bilirubin, creatinine, or INR raises the score continuously, so an increasing MELD score tracks increasing hepatic dysfunction and increasing three-month mortality risk.[1](https://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld/print) Its validity was judged by the concordance (c) statistic.[3](https://medschool.cuanschutz.edu/docs/librariesprovider60/education-docs/heartbeat-im-res/suggested-read/kamath-ps--meld-score-development-2001.pdf?sfvrsn=a35431b9_2)\n\n## How it is done\n\nA clinician enters the results of three blood tests into a calculator, such as the official MELD/PELD calculator published by the Organ Procurement and Transplantation Network (OPTN), the public-private partnership that runs the US system.[2](https://www.mayoclinic.org/tests-procedures/meld-score-liver-disease/about/pac-20590545) • [8](https://optn.transplant.hrsa.gov/media/qmsdjqst/meld-peld-calculator-user-guide.pdf) The UNOS implementation sets a lower limit of 1 for each component to avoid negative scores, caps serum creatinine at 4 mg/dl, and caps the score at 40.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) Under the calculation convention, creatinine is set to 4 mg/dl when it exceeds 4 mg/dl or when the patient was dialyzed at least twice, or received continuous 24-hour dialysis, in the last 7 days.[9](https://fpnotebook.com/GI/Exam/MldScr.htm) Patients are then ranked on the waiting list by score, with the highest-scoring patients prioritized for allograft allocation.[7](https://www.e-cmh.org/journal/view.php?number=1015)\n\n## Origin\n\nThe score descends from a risk model for patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures. A Cox proportional-hazards regression model was used to identify four variables, serum bilirubin, serum creatinine, INR, and the cause of the underlying liver disease, deriving the model from 231 patients at 4 US medical centers and validating it against 71 patients in the Netherlands.[10](https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-from-child-pugh-meld-score-beyond-S1665268121002349) The MELD score itself, a slight modification of that TIPS risk score, was reported by [Patrick S. Kamath](https://www.edgepedia.org/patrick-s-kamath) and colleagues in *Hepatology* in 2001, multiplied by 10 and rounded to the nearest integer for ease of use.[11](https://doi.org/10.1053/jhep.2001.22172) It was initially named Mayo End-stage Liver Disease and renamed Model for End-stage Liver Disease upon UNOS acceptance.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) A validation for allocation by Wiesner and colleagues in *Gastroenterology* in 2003 applied the score prospectively to 3437 adult candidates added to the OPTN waiting list between November 1999 and December 2001, of whom 412 (12%) died during 3-month follow-up.[5](https://pubmed.ncbi.nlm.nih.gov/12512033/) Kamath and Kim published a widely used overview of the score in *Hepatology* in 2007.[12](https://doi.org/10.1002/hep.21563)\n\n## Variants\n\nThe original formula was:\n\n\\[ \\text{MELD} = 3.8 \\cdot \\log_{e}(\\text{bilirubin}) + 11.2 \\cdot \\log_{e}(\\text{INR}) + 9.6 \\cdot \\log_{e}(\\text{creatinine}) + 6.4 \\cdot (\\text{etiology: 0 if cholestatic or alcoholic, 1 otherwise}) \\]\n\nmultiplied by 10 and rounded.[3](https://medschool.cuanschutz.edu/docs/librariesprovider60/education-docs/heartbeat-im-res/suggested-read/kamath-ps--meld-score-development-2001.pdf?sfvrsn=a35431b9_2) The UNOS version drops the etiology term, which proved unnecessary, and is computed as \\( 9.57 \\cdot \\log_{e}(\\text{creatinine}) + 3.78 \\cdot \\log_{e}(\\text{bilirubin}) + 11.20 \\cdot \\log_{e}(\\text{INR}) + 6.43 \\), with values below 1 set to 1.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) • [13](https://pmc.ncbi.nlm.nih.gov/articles/PMC11144281/)\n\n**MELD-Na** adds serum sodium, an independent predictor of waitlist mortality, and was adopted in 2016, lowering waitlist patient mortality by 27% without affecting post-transplant survival.[6](https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2026.1755115/full) Its formula is \\( \\text{MELD-Na} = \\text{MELD} + 1.32 \\cdot (137 - \\text{Na}) - 0.033 \\cdot \\text{MELD} \\cdot (137 - \\text{Na}) \\), with sodium bounded between 125 and 137 mEq/L.[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC11144281/)\n\n**MELD 3.0**, reported by W. Ray Kim and colleagues in *Gastroenterology* in 2021, is the third iteration of the score, following the original and MELD-Na versions.[14](https://doi.org/10.1053/j.gastro.2021.08.050) It adds female sex and serum albumin, lowers the creatinine ceiling from 4.0 to 3.0 mg/dL, and includes two interaction terms, bilirubin-sodium and albumin-creatinine:[15](https://www.sciencedirect.com/science/article/abs/pii/S0016508521034697)\n\n\\[ \\text{MELD 3.0} = 1.33\\,(\\text{if female}) + 4.56 \\cdot \\log_{e}(\\text{bilirubin}) + 0.82 \\cdot (137 - \\text{Na}) - 0.24 \\cdot (137 - \\text{Na}) \\cdot \\log_{e}(\\text{bilirubin}) + 9.09 \\cdot \\log_{e}(\\text{INR}) + 11.14 \\cdot \\log_{e}(\\text{creatinine}) + 1.85 \\cdot (3.5 - \\text{albumin}) - 1.83 \\cdot (3.5 - \\text{albumin}) \\cdot \\log_{e}(\\text{creatinine}) + 6 \\]\n\nwith bilirubin, INR, and creatinine below 1.0 set to 1.0, sodium confined to 125 to 137 mmol/L, albumin capped at 1.5 to 3.5 g/dL, and creatinine capped at 3.0 mg/dL.[16](https://www.gutnliver.org/journal/view.html?doi=10.5009%2Fgnl240584) • [13](https://pmc.ncbi.nlm.nih.gov/articles/PMC11144281/) It was implemented in the United States on July 15, 2023.[6](https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2026.1755115/full)\n\nOther named variants include updated MELD, refit MELD, integrated MELD, MESO (the ratio of MELD to serum sodium, \\( \\text{MESO} = (\\text{MELD}/\\text{Na}) \\times 10 \\)), UKELD (the UK end-stage liver disease score), and ReFit MELD-Na.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) • [17](https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition--382-articulo-comparison-prognostic-value-chronic-liver-S2444382417300597) MELD-XI, a version without INR, and a MELD-albumin score are used in cardiology for hepatorenal dysfunction in acute heart failure.[10](https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-from-child-pugh-meld-score-beyond-S1665268121002349) Germany transitioned to reMELD-Na, a refitted MELD-Na implemented by Eurotransplant, as of March 2025; it re-establishes bounds for creatinine, bilirubin, INR, and sodium and reduces the disproportionate influence of creatinine.[18](https://link.springer.com/article/10.1007/s00423-025-03846-x)\n\n## Applications\n\nThe score's main application is prioritization of liver transplant candidates, and mortality rises steeply with the score. In the prospective OPTN waitlist cohort, patients with MELD <9 had 1.9% three-month mortality versus 71.3% at MELD ≥40.[5](https://pubmed.ncbi.nlm.nih.gov/12512033/) A commonly cited estimate gives 3-month mortality of 4%, 27%, 76%, 83%, and 100% for MELD scores <10, 10-19, 20-29, 30-39, and ≥40 respectively.[4](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/) In the 2001 derivation work, the c-statistic for 3-month mortality was 0.87 in hospitalized patients, 0.80 in noncholestatic ambulatory patients, 0.87 in primary biliary cirrhosis patients, and 0.78 in historical cirrhotic patients.[3](https://medschool.cuanschutz.edu/docs/librariesprovider60/education-docs/heartbeat-im-res/suggested-read/kamath-ps--meld-score-development-2001.pdf?sfvrsn=a35431b9_2) A meta-analysis of 16 studies and 2337 patients found pooled AUROCs for mortality of 0.81 for Child-Turcotte-Pugh (CTP), 0.78 for MELD, 0.85 for MELD-Na, and 0.86 for MESO.[19](https://pubmed.ncbi.nlm.nih.gov/30568954/) MELD 3.0, derived from 29,410 waitlist candidates, showed improved discrimination versus MELD-Na (c-statistic 0.869 vs 0.862, p < 0.01) and re-stratified 8.8% of the derivation cohort to a higher score.[20](https://link.springer.com/article/10.1186/s12916-025-04185-w)\n\n## Limitations and alternatives\n\nMELD omits important prognostic predictors, including intractable hepatic encephalopathy, esophageal variceal bleeding, and spontaneous bacterial peritonitis.[7](https://www.e-cmh.org/journal/view.php?number=1015) It was created and validated in a cohort without acute, reversible complications such as bacterial infection or azotemia, so it should be calculated only after such processes are treated.[7](https://www.e-cmh.org/journal/view.php?number=1015) The score underestimates mortality in women, possibly because of reduced creatinine production, contributing to higher waitlist mortality in female patients.[20](https://link.springer.com/article/10.1186/s12916-025-04185-w) Against Child-Pugh, MELD shows higher specificity while Child-Pugh shows higher sensitivity in patients with acute-on-chronic liver failure (ACLF).[21](https://www.ovid.com/jnls/md-journal/fulltext/10.1097/md.0000000000002877~childpugh-versus-meld-score-for-the-assessment-of-prognosis) For 28-day mortality in ACLF, the Chronic Liver Failure Consortium ACLF score outperformed both MELD and MELD-Na (c-statistic 0.760 versus 0.687 and 0.684, respectively; p < 0.001 for both).[22](https://journals.lww.com/transplantjournal/fulltext/2022/11000/are_meld_and_meldna_still_reliable_tools_to.10.aspx)\n\nMELD 3.0 is expected to reduce overall waitlist mortality modestly and improve access for female transplant candidates.[23](https://www.annualreviews.org/content/journals/10.1146/annurev-med-051322-122539) Emerging evidence complicates that expectation: across the MELD-Na and MELD 3.0 eras, waitlisted females experienced a 16.28% mean increase in the relative 180-day median hazard ratio compared with males, suggesting persistent sex disparity after MELD 3.0.[6](https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2026.1755115/full) One external retrospective study of 6071 transplant candidates found female sex was not an independent predictor once incorporated with MELD 3.0 in Cox regression.[20](https://link.springer.com/article/10.1186/s12916-025-04185-w) The utility of MELD 3.0 for risk stratification in surgery and TIPS requires further study.[23](https://www.annualreviews.org/content/journals/10.1146/annurev-med-051322-122539)\n\n## References\n\n1. [Model for End-stage Liver Disease (MELD) - UpToDate](https://www.uptodate.com/contents/model-for-end-stage-liver-disease-meld/print)\n2. [MELD (model for end-stage liver disease) score, Mayo Clinic](https://www.mayoclinic.org/tests-procedures/meld-score-liver-disease/about/pac-20590545)\n3. [A model to predict survival in patients with end-stage liver disease (Kamath et al., Hepatology 2001;33:464-470)](https://medschool.cuanschutz.edu/docs/librariesprovider60/education-docs/heartbeat-im-res/suggested-read/kamath-ps--meld-score-development-2001.pdf?sfvrsn=a35431b9_2)\n4. [Model for End-stage Liver Disease (review)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/)\n5. [Model for end-stage liver disease (MELD) and allocation of donor livers (Gastroenterology 2003)](https://pubmed.ncbi.nlm.nih.gov/12512033/)\n6. [Sex-based survival disparities persist in liver transplantation: MELD 3.0 fails to improve survival for waitlisted women (Frontiers in Transplantation)](https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2026.1755115/full)\n7. [Important predictor of mortality in patients with end-stage liver disease (Clinical and Molecular Hepatology)](https://www.e-cmh.org/journal/view.php?number=1015)\n8. [MELD PELD Calculator User Guide (OPTN/HRSA)](https://optn.transplant.hrsa.gov/media/qmsdjqst/meld-peld-calculator-user-guide.pdf)\n9. [MELD Score, FPnotebook](https://fpnotebook.com/GI/Exam/MldScr.htm)\n10. [From Child-Pugh to MELD score and beyond: Taking a walk down memory lane (Annals of Hepatology)](https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-from-child-pugh-meld-score-beyond-S1665268121002349)\n11. [Patrick S. Kamath and colleagues (2001). A Model to Predict Survival in Patients With End–Stage Liver Disease. Hepatology.](https://doi.org/10.1053/jhep.2001.22172)\n12. [Patrick S. Kamath, Ray W. Kim (2007). The model for end-stage liver disease (MELD). Hepatology.](https://doi.org/10.1002/hep.21563)\n13. [MELD3.0 is superior to MELDNa and MELD for prediction of mortality in patients with cirrhosis: An external validation in a multi-ethnic population](https://pmc.ncbi.nlm.nih.gov/articles/PMC11144281/)\n14. [W. Ray Kim and colleagues (2021). MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology.](https://doi.org/10.1053/j.gastro.2021.08.050)\n15. [MELD 3.0: The Model for End-stage Liver Disease Updated for the Modern Era (Gastroenterology, publisher page)](https://www.sciencedirect.com/science/article/abs/pii/S0016508521034697)\n16. [Predicting Mortality and Cirrhosis-Related Complications with MELD3.0: A Multicenter Cohort Analysis (Gut and Liver)](https://www.gutnliver.org/journal/view.html?doi=10.5009%2Fgnl240584)\n17. [Comparison of the prognostic value of Chronic Liver Failure Consortium scores and traditional models for predicting mortality in patients with cirrhosis](https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition--382-articulo-comparison-prognostic-value-chronic-liver-S2444382417300597)\n18. [Validation of MELD 3.0 and ReMELD-Na scoring systems: a German clinical cohort study (Langenbeck's Archives of Surgery)](https://link.springer.com/article/10.1007/s00423-025-03846-x)\n19. [Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy](https://pubmed.ncbi.nlm.nih.gov/30568954/)\n20. [The unwell patient with advanced chronic liver disease: when to use each score? (BMC Medicine)](https://link.springer.com/article/10.1186/s12916-025-04185-w)\n21. [Child–Pugh Versus MELD Score for the Assessment of Prognosis (Medicine)](https://www.ovid.com/jnls/md-journal/fulltext/10.1097/md.0000000000002877~childpugh-versus-meld-score-for-the-assessment-of-prognosis)\n22. [Are MELD and MELDNa Still Reliable Tools to Predict Mortality on the Liver Transplant Waiting List? (Transplantation)](https://journals.lww.com/transplantjournal/fulltext/2022/11000/are_meld_and_meldna_still_reliable_tools_to.10.aspx)\n23. [MELD 3.0 in Advanced Chronic Liver Disease (Annual Review of Medicine)](https://www.annualreviews.org/content/journals/10.1146/annurev-med-051322-122539)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Organ and tissue transplantation › Titles Li to X*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n", "same_as": [], "url": "https://www.edgepedia.org/model-for-end-stage-liver-disease-score", "markdown_url": "https://www.edgepedia.org/model-for-end-stage-liver-disease-score.md", "license": { "name": "Edgepedia Community License 1.0", "url": "https://www.edgepedia.org/edgepedia/license", "summary": "Free with credit, commercial use included. AI training is open to everyone. 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Edgepedia Community License 1.0.", "speakable": "The Model for End-stage Liver Disease score predicts three-month mortality in chronic liver disease from three blood tests, and has prioritized US liver transplant candidates since 2002." }