Model for End-Stage Liver Disease — sodium-adjusted (UNOS 2016) and MELD 3.0 (UNOS 2023) for cirrhosis severity, 3-month mortality and transplant listing. Calculations run locally in your browser.
Disclaimer: The MELD score estimates 3-month mortality from chronic liver disease and is an allocation tool — it does not replace clinical assessment. It is not validated in patients <12 years, in acute liver failure (use King's College Criteria), or in acute-on-chronic liver failure (use CLIF-C ACLF or AARC). Always confirm with your hepatology and transplant team before listing decisions.
Hyponatraemia in cirrhosis reflects circulatory dysfunction and predicts mortality independently of MELD. Adding sodium (Kim 2008) reclassified ~27% of waitlist deaths and reduced mortality on the U.S. waitlist by ~3–7%. UNOS adopted MELD-Na in January 2016. The Na correction is applied only when MELD > 11, and sodium is bounded between 125 and 137 mEq/L.
Kim et al. (2021) showed MELD-Na under-prioritised women (lower creatinine for the same true GFR) and patients with low albumin. MELD 3.0 adds female sex (+1.33), albumin and interaction terms; caps creatinine at 3.0 mg/dL instead of 4.0; and applies a continuous sodium correction. UNOS switched to MELD 3.0 in July 2023. Listing threshold is unchanged at ≥15; exception points (HCC, hepatopulmonary syndrome, etc.) are added on top.
Transplant survival benefit over remaining on the waitlist crosses zero at MELD ~15 (Merion 2005). Most centres begin formal transplant work-up at MELD ≥15, or earlier for HCC within Milan criteria, refractory ascites, recurrent variceal bleed, hepatopulmonary syndrome or porto-pulmonary hypertension. In India, NOTTO allocation prioritises by MELD-Na with standardised exception points. Living-donor transplant in India is not strictly MELD-driven but most programmes activate evaluation at MELD ≥15 or with significant decompensation.
If the patient received ≥2 sessions of haemodialysis OR ≥24 hours of continuous renal replacement therapy in the prior 7 days, set creatinine to the cap (4.0 for MELD-Na, 3.0 for MELD 3.0). This prevents "gaming" the score by improving creatinine through dialysis.
Six. All three lab values are floored at 1.0 inside the natural logarithm (ln 1 = 0), so the minimum is 0.643 × 10 ≈ 6. The maximum allocation MELD in UNOS is 40 — scores above 40 are capped for listing purposes although the raw value remains prognostic.
MELD/MELD-Na underestimates short-term mortality in ACLF because the prognosis is driven by extra-hepatic organ failures. Use the CLIF-C ACLF score (EASL-CLIF, Europe) or the AARC score (APASL, widely used in India). A CLIF-C ACLF >64 at day 3–7 predicts >90% 28-day mortality and informs futility decisions.
3-month mortality bands from Wiesner et al. (2003) and OPTN registry data. Always defer to your transplant centre's listing protocol.
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