Printed on 3/17/2026
For informational purposes only. This is not medical advice.
The Model for End-Stage Liver Disease (MELD) score is a numerical scale used to assess the severity of chronic liver disease and prioritize organ allocation for liver transplantation. Originally developed to predict 3-month mortality following TIPS procedures, it is now the standard tool used by UNOS for liver transplant allocation in the United States. The MELD-Na variant incorporates serum sodium for improved prediction.
Formula: MELD = 10 × (0.957×ln(Cr) + 0.378×ln(Bili) + 1.120×ln(INR) + 0.643)
Input total bilirubin (mg/dL), INR, serum creatinine (mg/dL), and optionally serum sodium (mEq/L). These should be recent values from within the past few days.
The calculator applies the UNOS formula using natural logarithms of bilirubin, INR, and creatinine. If sodium is provided, MELD-Na is also calculated.
Compare your score to established mortality ranges. Scores ≥15 typically warrant transplant evaluation; scores ≥30 indicate high urgency with significant 3-month mortality risk.
Hepatologists, transplant coordinators
Determine MELD-Na for UNOS transplant list prioritization. Higher scores receive organs first. MELD-Na has been the allocation standard since January 2016.
Hepatologists, patients
Assess when to list for transplant. MELD <15 may indicate observation is appropriate; MELD ≥15 typically warrants listing; MELD ≥30 indicates urgency.
Physicians, palliative care teams
Estimate 3-month mortality to guide goals-of-care discussions. MELD helps quantify disease trajectory for patients and families.
Interventional radiologists, hepatologists
MELD was originally developed to predict post-TIPS mortality. MELD >18-20 carries higher procedural risk; very high MELD may contraindicate TIPS. Use [APACHE II](/tools/apache-ii-score) or [SOFA Score](/tools/sofa-score) for comprehensive ICU risk assessment if post-procedure critical care is anticipated.
Hepatology clinics
Track MELD over time to assess disease progression or improvement. Rising MELD indicates worsening liver function and may accelerate transplant evaluation.
Transplant committees
Identify patients whose MELD underestimates severity (HCC, hepatopulmonary syndrome, PSC cholangitis) for UNOS exception point applications.
Since January 2016, UNOS uses MELD-Na (incorporating sodium) rather than original MELD for liver allocation. Hyponatremia worsens prognosis independently, so MELD-Na better predicts mortality.
In the UNOS formula, creatinine is capped at 4.0. Values above this don't increase the score further. Patients on dialysis are automatically assigned Cr = 4.0.
Per UNOS, if bilirubin, INR, or creatinine is below 1.0, it is set to 1.0 for the calculation. This prevents negative logarithm issues and sets a floor on the score.
Conditions like hepatocellular carcinoma, hepatopulmonary syndrome, cholangitis, and intractable ascites carry high mortality but may produce low MELD scores. Exception points address this gap.
All lab values should be from the same draw date. Mixing values from different dates can produce inaccurate scores. Transplant centers require labs within 48-72 hours of listing.
Pre-renal azotemia, hepatorenal syndrome, or acute tubular necrosis can spike creatinine, dramatically raising MELD. This may or may not reflect true liver disease severity. Use [eGFR Calculator](/tools/egfr-calculator) or [Creatinine Clearance](/tools/creatinine-clearance) to assess baseline renal function. Clinical context matters.
As of March 2025, UNOS adopted MELD 3.0, which adds sex and serum albumin as variables with recalibrated coefficients. This update reduces sex disparities in liver allocation — women now receive fairer prioritization. See [Corrected Calcium](/tools/corrected-calcium) for another example of albumin-adjusted lab interpretations. Check with your transplant center if they're using MELD 3.0 or MELD-Na.
A MELD increasing from 15 to 25 over 3 months indicates rapid decompensation. A stable MELD of 20 for years suggests compensated cirrhosis. Serial values tell the story.
Even MELD 10-15 carries meaningful mortality risk. Variceal bleeding, encephalopathy, and infections can cause death regardless of MELD. The score estimates average risk, not individual fate.
[Child-Pugh](/tools/child-pugh) includes ascites and encephalopathy (clinical assessments MELD misses). MELD is better for transplant allocation; Child-Pugh may better predict surgical risk and overall prognosis.
MELD was developed by Kamath et al. (Hepatology 2001) and adopted by UNOS for liver allocation in 2002. MELD-Na (Biggins et al., Gastroenterology 2006) became the allocation standard in January 2016. MELD 3.0 was implemented in March 2025, adding sex and albumin variables to reduce allocation disparities, particularly for female patients. This calculator uses MELD-Na; check with transplant centers for MELD 3.0-specific calculations. Mortality estimates are from validation cohorts and UNOS registry data.
The MELD score ranges from 6 to 40 and predicts 3-month mortality in patients with chronic liver disease. A score below 10 suggests relatively stable disease with low short-term mortality (less than 2%). Scores of 10–19 indicate moderate disease with increasing mortality risk (6–20%). Scores of 20–29 represent serious liver disease with substantial mortality risk. Scores of 30 or above indicate very severe disease with a 3-month mortality exceeding 50%.
If you provided serum sodium, the MELD-Na score is also calculated. MELD-Na generally provides a more accurate mortality prediction than standard MELD, particularly in patients with ascites and hyponatremia — conditions where sodium levels reflect disease severity not captured by bilirubin, INR, and creatinine alone.
The MELD score is primarily used to determine priority for liver transplant allocation. In the United States, UNOS uses the MELD-Na score to rank patients on the transplant waiting list — higher scores receive higher priority. It is also used to assess prognosis in patients with cirrhosis, guide the timing of transplant referral, and predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) procedures.
Clinicians also use the MELD score to help guide decisions about the urgency of interventions, monitoring frequency, and discussions about goals of care in advanced liver disease.
The MELD score uses only three laboratory values and does not capture several clinically important aspects of liver disease. Conditions like hepatocellular carcinoma, hepatopulmonary syndrome, recurrent cholangitis, and intractable ascites may carry high mortality but produce a low MELD score. UNOS addresses this through exception points for specific conditions.
Creatinine — one of the three MELD inputs — is influenced by factors beyond liver and kidney function. Patients with low muscle mass (common in advanced cirrhosis) may have misleadingly low creatinine values, leading to MELD scores that underestimate disease severity. Additionally, creatinine is capped at 4.0 mg/dL in the formula, and patients on dialysis are automatically assigned a creatinine of 4.0.
Lab values can fluctuate with acute illness, dehydration, or infection. A single MELD score is a snapshot — serial measurements and trend analysis provide a more complete clinical picture.
For related assessments, see Child-Pugh Score and eGFR Calculator.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
Calculate the Child-Pugh score to classify the severity of chronic liver disease and estimate prognosis. Uses bilirubin, albumin, INR, ascites, and encephalopathy.
ClinicalCalculate estimated glomerular filtration rate (eGFR) using the CKD-EPI 2021 race-free equation. Free kidney function assessment with CKD staging from serum creatinine.