Also known as MELD 3.0, MELD, Model for End-Stage Liver Disease
Liver disease severity score from five laboratory values, dialysis and sex.
Applies to / doesn’t apply to3
Applies to: Adults registered on, or being assessed for, the US liver-transplant waiting list. The model was derived and validated in 29,410 adults newly waitlisted in the US between January 2016 and December 2018 (OPTN registry), split 70:30 into development and validation sets (Kim 2021).
- Children under 12. OPTN scores them with PELD, not MELD (OPTN Policy 9.1.E).
- Candidates registered on the waiting list before age 18. OPTN scores them with a different form with no sex term and a constant of 7.33; this tool computes only the adult form (OPTN Policy 9.1.D).
- Candidates listed for a multi-organ transplant other than simultaneous liver–kidney, after a previous liver transplant, or with exception points at registration. These groups were excluded from the derivation (Kim 2021).
Female adds 1.33 points. OPTN uses "sex for purposes of adult MELD calculation", which the clinical team may set differently from birth sex, for example during feminizing hormone therapy.
Yes if, in the 7 days before the creatinine was drawn, the patient had dialysis at least twice or 24 hours of continuous veno-venous hemodialysis (CVVHD). If yes, creatinine is set to 3.0 mg/dL.
As reported. Values below 1.0 count as 1.0 and above 3.0 as 3.0 mg/dL.
Serum total bilirubin. Values below 1.0 mg/dL count as 1.0.
Values below 1.0 count as 1.0.
mmol/L, the same number as mEq/L. Bounded to 125–137 before the formula.
Bounded to 1.5–3.5 g/dL (15–35 g/L) before the formula.
What this score estimates
MELD 3.0 combines sex, total bilirubin, serum sodium, INR, serum creatinine and serum albumin into one score for the severity of chronic liver disease. It was fitted to 90-day waiting-list mortality — removal from the US liver-transplant waiting list for death or for being too sick, censored at transplant (Kim 2021) — and is the version of MELD in OPTN policy since 13 July 2023. Each lab is bounded before the formula, and every bound this tool applies is shown with the result, alongside the 90-day survival the paper’s own survival function gives for the score.
Pearls & pitfalls
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- Discrimination for 90-day waiting-list mortality in the internal validation set was a C-statistic of 0.869, against 0.862 for MELD-Na, in the same US registry era as the development set, and 0.868 against 0.864 in 10,459 US registrations from 2019 (Kim 2021).
- Performance has been lower outside that population. In 2,153 waitlisted patients in Korea, the C-index for 3-month survival was 0.738 for MELD 3.0 against 0.730 for MELD-Na, not a significant difference (Yoo 2023).
- Creatinine depends on muscle mass and overstates kidney function when muscle mass is low. The 1.33 points for female sex address this on average; low muscle mass from sarcopenia or malnutrition in an individual, of either sex, is not corrected (Kim 2021).
- Every lab is bounded before the formula: bilirubin, INR and creatinine below 1.0 count as 1.0; creatinine above 3.0 mg/dL counts as 3.0; sodium counts within 125–137 mmol/L and albumin within 1.5–3.5 g/dL. Values beyond a bound add nothing further to the score (OPTN Policy 9.1.D).
- OPTN policy caps the score at 40; the derivation paper set no cap and observed higher waiting-list mortality above 40 than at 40 (Kim 2021). A computed value above 40 is reported as 40 and disclosed beside the result.
- The dialysis rule — creatinine set to 3.0 mg/dL after two or more dialysis treatments, or 24 hours of CVVHD, in the 7 days before the creatinine test — comes from OPTN policy, not the derivation paper (OPTN Policy 9.1.D).
Risk factors the score does not count:
- Complications not reflected in the labs, such as ascites, hepatic encephalopathy or variceal bleeding.
- Hepatocellular carcinoma and the other conditions OPTN handles through exception points, which this tool does not compute.
- Muscle mass, frailty and nutritional status.
What the guidelines say
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MELD 3.0 is the MELD score in OPTN policy for liver candidates registered at 18 or older, replacing MELD-Na; OPTN describes MELD and PELD as reflecting the probability of death on the waiting list within 90 days. The OPTN Board approved the change in June 2022, and it took effect on 13 July 2023.
Guideline positions are stated as published. Curie.MD Calc does not publish treatment direction.
Where this comes from
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References
- Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: the model for end-stage liver disease updated for the modern era. Gastroenterology. 2021;161(6):1887-1895.e4. View source ↗
- Organ Procurement and Transplantation Network. OPTN Policies, Policy 9.1.D: MELD Score, and Policy 9.1.E: PELD Score. MELD 3.0 approved by the OPTN Board of Directors 27 June 2022; implementation planned 13 July 2023. View source ↗
- Yoo JJ, Chang JI, Moon JE, et al. Validation of MELD 3.0 scoring system in East Asian patients with cirrhosis awaiting liver transplantation. Liver Transpl. 2023;29(10):1029-1040. View source ↗