MELD-Na Score (Model For End-Stage Liver Disease)
MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin
mg/dL) + 1.120 x
Ln(INR) + 0.643 )
For candidates with an initial MELD score greater
than 11, the MELD score is then re-calculated as follows:
MELDNa = MELD(i) + 1.32*(137-Na)
- Sodium values less than 125 mmol/L will be set to 125, and
values greater than 137 mmol/L will be set to 137.
- Any value less than one is given a value of 1 to prevent a
MELD score calculation
Serum Total Bilirubin:
[Normal: < 1.2 mg/dL (0.1 -1.2 mg/dL)]
Has the patient had dialysis at least twice in the prior 7 days
(or) received 24 hours of continuous veno-venous hemodialysis (CVVHD)
within the prior 7 days?
The Model for End-Stage Liver Disease (MELD) is a useful tool in predicting the
probability of death from liver disease and how urgently an individual needs a
liver transplant in the next three months. The MELD score is based on a
patient’s serum creatinine, INR and bilirubin, as these were found to most
accurately correlate with mortality within a three month period. The score
ranges in value from 6 (lowest priority) to 40 (highest priority). Lab values
must be updated according to the UNOS Recertification Schedule, otherwise
patients will automatically revert to the previous MELD score.
(age 12 and older)
Important policy changes including 'Clerical Changes for
Implementation of Adding Serum Sodium to the MELD Score'
United Network for Organ Sharing proposed that MELD-Na score (an
extension of MELD) may better rank candidates based on their risk of
pre-transplant mortality and is projected to save 50-60 lives total
- Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg
CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in
patients with end-stage liver disease. Hepatology. 2001
- Kamath PS, Kim WR; Advanced Liver Disease Study Group. The model for
end-stage liver disease (MELD). Hepatology. 2007 Mar;45(3):797-805. [Pubmed]
- Wiesner, Russell; Edwards, Erick; Freeman, Richard; Harper, Ann;
Kim, Ray; Kamath, Patrick; Kremers, Walter; Lake, John; Howard, Todd;
Merion, Robert M; Wolfe, Robert A; Krom, Ruud; United Network for Organ
Sharing Liver Disease Severity Score Committee (2003). "Model for
end-stage liver disease (MELD) and allocation of donor livers".
Gastroenterology. 124 (1): 91-6.