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MELD-Na & MELD 3.0 Calculator

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.

MELD 3.0 (Kim 2021) replaced MELD-Na for U.S. allocation in July 2023. It adds female sex and albumin and corrects historical under-prioritisation of women. India's NOTTO has not yet mandated MELD 3.0 — most Indian transplant programmes still allocate on MELD-Na, but MELD 3.0 is increasingly used for prognostication.

Laboratory values

Clinical context

MELD Score

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.

Frequently asked questions

Why is MELD-Na better than the original MELD?

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.

What changed in MELD 3.0?

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.

When should I list a patient for transplant?

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.

What if the patient is on dialysis?

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.

What is the lowest possible MELD-Na?

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.

What about MELD in acute-on-chronic liver failure (ACLF)?

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.

References

  1. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33(2):464–470.
  2. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359(10):1018–1026.
  3. Merion RM, Schaubel DE, Dykstra DM, et al. The survival benefit of liver transplantation. Am J Transplant 2005;5(2):307–313.
  4. 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.
  5. OPTN/UNOS Policy 9: Allocation of Livers and Liver-Intestines. Effective July 2023.
  6. Sarin SK, Choudhury A, Sharma MK, et al. APASL ACLF Research Consortium (AARC) Score. Hepatol Int 2019;13:353–390.
  7. NOTTO Standard Operating Procedures for Deceased Donor Liver Allocation, 2022.

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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