Transplant hepatology
MELD & MELD-Na Score
The Model for End-Stage Liver Disease (MELD) prioritizes liver transplant allocation and predicts mortality. Enter lab values and dialysis status to calculate both MELD and MELD-Na.
If on dialysis twice in past 7 days, creatinine automatically set to 4.0.
MELD-Na clamps sodium between 125 and 137 mmol/L.
Normalized inputs
- Bilirubin (floor 1): 3.20
- INR (floor 1): 1.80
- Creatinine (1–4): 1.40
- Na (clamped 125–137): 134
MELD score
20.6
Baseline log-transformed formula
MELD-Na score
22.5
Moderate mortality riskMELD-Na 15–24 warrants close monitoring, optimization of comorbidities, and transplant referral if not already listed.
Use in conjunction with Child-Pugh, liver imaging, and transplant listing criteria.
How to Use This Calculator
Use current labs
Collect bilirubin, INR, creatinine, and sodium from the same lab draw. Note dialysis sessions in the previous week.
Enter values and confirm assumptions
The calculator applies MELD floors/ceilings and the standard MELD-Na adjustment automatically.
Interpret in context
MELD-Na guides transplant priority but should be combined with clinical status, complications, and transplant center policies.
Formula
MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43
Laboratory values are floored at 1.0; creatinine capped at 4.0. If on dialysis twice in the prior week, creatinine is set to 4.0.
MELD-Na = MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na), with Na constrained to 125–137 mmol/L.
Full Description
The MELD score predicts 90-day mortality in advanced liver disease and determines priority for liver transplantation in many regions. MELD-Na incorporates serum sodium to improve prognostic accuracy, particularly for patients with hyponatremia.
Limitations include unreliable INR in patients on anticoagulants, fluctuating labs during acute decompensation, and conditions not adequately captured by MELD (e.g., hepatocellular carcinoma). Complement with clinical judgement, imaging, and other scoring systems (Child-Pugh, CLIF-C ACLF).
Frequently Asked Questions
How often should MELD be recalculated?
Depends on transplant center policy; typically every 7–14 days for MELD ≥25 and monthly for lower scores. Update after major clinical changes.
Does warfarin therapy affect MELD?
Yes. INR may be falsely elevated by warfarin, overestimating MELD. Document anticoagulant use and consider alternative assessments.
When do I report MELD vs MELD-Na?
MELD-Na is standard for transplant allocation (OPTN/UNOS). Some publications still reference original MELD; report both for clarity.
What about patients with creatinine <1 mg/dL?
The MELD formula floors labs at 1.0 to avoid negative logs. This may underestimate mortality in patients with sarcopenia or low muscle mass.