What is a normal MELD score?

There is no "normal" MELD score in the same way as a normal lab value. The minimum MELD score is approximately 6 (all inputs at minimum values). A MELD < 10 indicates low severity liver disease with approximately 1.9% 90-day mortality. MELD ≥ 15 is when deceased donor liver transplant allocation becomes active in the UNOS system. Scores ≥ 40 represent maximum allocation priority.

What is the difference between MELD and MELD-Na?

MELD uses three variables: creatinine, bilirubin, and INR. MELD-Na (adopted by UNOS in 2016) adds serum sodium because hyponatremia (Na < 135 mEq/L) in cirrhosis is independently associated with higher 90-day waitlist mortality. MELD-Na better captures patients with severe ascites and dilutional hyponatremia who have higher mortality risk than their MELD alone suggests.

What MELD score qualifies for liver transplant?

In the US UNOS system, patients are listed for liver transplant once MELD-Na ≥ 15, as the survival benefit of transplantation exceeds the surgical mortality risk. Patients with MELD-Na < 15 have better outcomes without transplantation than after it, on average. Exception points may increase effective MELD for HCC, hepatopulmonary syndrome, or other qualifying conditions.

Can MELD score improve?

Yes. MELD is a dynamic score that can improve with treatment of precipitating factors (infection, GI bleeding, drug hepatotoxicity withdrawal, HCV cure). In alcoholic liver disease, MELD can significantly improve with alcohol abstinence and nutritional support. Serial MELD measurements track disease trajectory and response to treatment.

Medically Reviewed · CliniqWise Clinical Advisory Board — Hepatology & Transplant Medicine Panel · Updated 2026-08-27

MELD Score Calculator — Model for End-Stage Liver Disease Severity & Transplant Priority

Q: What is the difference between MELD and MELD-Na?

MELD uses three variables: creatinine, bilirubin, and INR. MELD-Na (adopted by UNOS in 2016) adds serum sodium because hyponatremia (Na < 135 mEq/L) in cirrhosis is independently associated with higher 90-day waitlist mortality. MELD-Na better captures patients with severe ascites and dilutional hyponatremia who have higher mortality risk than their MELD alone suggests.

Q: What MELD score qualifies for liver transplant?

In the US UNOS system, patients are listed for liver transplant once MELD-Na ≥ 15, as the survival benefit of transplantation exceeds the surgical mortality risk. Patients with MELD-Na < 15 have better outcomes without transplantation than after it, on average. Exception points may increase effective MELD for HCC, hepatopulmonary syndrome, or other qualifying conditions.

Q: Can MELD score improve?

Yes. MELD is a dynamic score that can improve with treatment of precipitating factors (infection, GI bleeding, drug hepatotoxicity withdrawal, HCV cure). In alcoholic liver disease, MELD can significantly improve with alcohol abstinence and nutritional support. Serial MELD measurements track disease trajectory and response to treatment.

Calculate the MELD score (Model for End-Stage Liver Disease) from creatinine, bilirubin, and INR to assess liver disease severity and prioritize liver transplant allocation.

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MELD Score Calculator

Enter values below to calculate

Serum Creatinine*

mg/dL

Capped at 4.0 for MELD. Use 4.0 if on dialysis ≥ 2×/week.

Serum Total Bilirubin*

mg/dL

Total bilirubin from hepatic panel.

INR (Prothrombin Time)*

INR

International Normalized Ratio. Reflects liver synthetic function.

Serum Sodium (for MELD-Na)

mEq/L

Optional. Required for MELD-Na. UNOS caps at 137, floors at 125 mEq/L.

This calculator is for informational and educational purposes. Results should be interpreted with clinical judgment and local guidelines.

What is the MELD Score?

The MELD score (Model for End-Stage Liver Disease) is an objective, laboratory-based scoring system used to estimate the 90-day mortality risk in patients with end-stage liver disease and to prioritize liver transplant allocation. Originally developed in 2000 by the Mayo Clinic to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) procedure and adopted by UNOS (United Network for Organ Sharing) for transplant allocation in 2002. The MELD score uses three laboratory values: serum creatinine (kidney function), serum total bilirubin (liver excretory function), and INR (liver synthetic function). In 2016, MELD-Na was adopted by UNOS, adding serum sodium to the formula to better capture patients with dilutional hyponatremia who have higher mortality risk. MELD 3.0, released in 2021, further refines the model by adding sex (female) and albumin to address female-specific mortality risk that older MELD underestimated.

MELD = 3.78 × ln(Bilirubin mg/dL) + 11.2 × ln(INR) + 9.57 × ln(Creatinine mg/dL) + 6.43. Score range: 6 (lowest severity) to 40+ (highest). MELD < 10: 1.9% mortality; MELD ≥ 40: 71.3% 90-day mortality.

When to Use the MELD Score Calculator

Liver transplant waitlist prioritization: MELD score is the primary metric used by UNOS/OPTN for deceased donor liver allocation in the United States. Patients with MELD ≥ 15 receive priority over those with MELD < 15 for deceased donor organs.
Prognosis counseling in cirrhosis: MELD provides objective 90-day mortality risk estimation for patients with alcoholic cirrhosis, viral hepatitis cirrhosis (HBV, HCV), autoimmune hepatitis, and other end-stage liver diseases.
Acute alcoholic hepatitis: MELD ≥ 21 in severe alcoholic hepatitis correlates with indication for corticosteroid therapy (prednisolone 40mg/day × 28 days) per EASL and ACG guidelines, though the Maddrey discriminant function (DF ≥ 32) is also used.
Post-TIPS procedural risk: MELD was originally derived to predict 3-month survival after TIPS. MELD ≥ 18 before TIPS is associated with 50% 30-day mortality.
Cirrhosis complication management: Regular MELD monitoring in admitted cirrhotics guides intensity of care, timing of hepatology referral, and listing decisions.
Spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS): MELD-Na captures sodium-related outcomes in patients with ascites-related complications.

Liver CirrhosisEnd-Stage Liver DiseaseAcute Alcoholic HepatitisLiver Transplant CandidacyHepatorenal SyndromePost-TIPS AssessmentHepatitis B/C CirrhosisAutoimmune HepatitisPrimary Biliary Cholangitis

MELD Score Formula & MELD-Na Extension

MELD Score (Original UNOS Formula)

MELD = 3.78 × ln(Bilirubin) + 11.2 × ln(INR) + 9.57 × ln(Creatinine) + 6.43

Bilirubin = 2.0 mg/dL, INR = 1.8, Creatinine = 1.5 mg/dL → MELD = 3.78×ln(2) + 11.2×ln(1.8) + 9.57×ln(1.5) + 6.43 ≈ 16

MELD-Na (Adopted by UNOS 2016)

MELD-Na = MELD − Na − (0.025 × MELD × (140 − Na)) + 140

MELD = 16, Na = 130 → MELD-Na = 16 − 130 − (0.025 × 16 × 10) + 140 ≈ 22 (higher priority due to hyponatremia)

Input Caps & Floors (UNOS rules)

Creatinine capped at 4.0 mg/dL (or 4.0 if on dialysis ≥ twice/week). Minimum value for all inputs: 1.0 mg/dL (to avoid negative log values). Maximum MELD for allocation: 40.

If Creatinine = 0.6 mg/dL → use 1.0 mg/dL for calculation. If MELD calculates as 42 → report as 40.

Variables

Serum Creatinine (mg/dL)

Reflects kidney function. Capped at 4.0 mg/dL. Minimum 1.0 mg/dL used in formula. Values > 4.0 or on hemodialysis → use 4.0.

Serum Bilirubin (Total) (mg/dL)

Reflects liver excretory function. Minimum 1.0 mg/dL used in formula. Higher values indicate severe cholestasis or hepatocellular failure.

INR (International Normalized Ratio) (dimensionless)

Reflects liver synthetic (coagulation factor) function. Minimum 1.0 used in formula. Not affected by vitamin K supplementation in formula calculation.

Serum Sodium (mEq/L)

Required for MELD-Na only. Capped at 137 mEq/L (max) and floored at 125 mEq/L (min). Corrected sodium used (corrected for hyperglycemia if present).

All values below 1.0 are set to 1.0 before applying the natural logarithm (to avoid negative numbers). MELD-Na includes sodium as it captures patients with dilutional hyponatremia who have higher mortality risk independent of liver-specific parameters. The 2021 MELD 3.0 formula adds serum albumin and female sex (+1.33 points) to improve accuracy in women.

MELD Score Interpretation — 90-Day Mortality Risk

MELD score correlates with 90-day waitlist mortality in end-stage liver disease. UNOS uses MELD-Na ≥ 15 as the threshold for deceased donor liver transplant consideration.

Range	Classification	Health Risk
< 10	Low Severity	~1.9% 90-day mortality. Outpatient management. Consider transplant evaluation if progressive disease.
10–19	Moderate Severity	~6–20% 90-day mortality. Hospitalization likely. Transplant workup initiation. Active UNOS listing if MELD-Na ≥ 15.
20–29	Significant Severity	~20–52% 90-day mortality. Active transplant listing. Intensive hepatology monitoring. Consider TIPS if appropriate.
30–39	High Severity	~52–60% 90-day mortality. High transplant priority. ICU-level care for complications. Aggressive listing strategy.
≥ 40	Critical — Very High Mortality	~71.3% 90-day mortality. Highest transplant urgency. Multidisciplinary critical care. UNOS maximum allocation score.

MELD score alone does NOT determine transplant eligibility. Transplant candidacy requires comprehensive evaluation including psychosocial assessment, sobriety documentation (for alcoholic liver disease), malignancy screening (HCC), cardiac evaluation, and multidisciplinary team review.

MELD Score Limitations & Clinical Warnings

Does not capture all complications: MELD does not directly account for refractory ascites, recurrent hepatic encephalopathy, hepatopulmonary syndrome, portopulmonary hypertension, or HCC — all of which qualify for MELD exception points in the UNOS system.

Creatinine limitations in cirrhosis: Serum creatinine underestimates true GFR in cirrhotic patients due to reduced hepatic creatinine production. Sarcopenic patients may have normal creatinine despite significantly impaired renal function.

MELD 3.0 is replacing original MELD: The 2021 MELD 3.0 formula (which adds sex and albumin) has been adopted by UNOS for US transplant allocation from May 2022. The original MELD formula remains widely used internationally and in non-transplant clinical settings.

Not validated for acute liver failure (ALF): MELD was developed for chronic end-stage liver disease. Acute liver failure prognosis uses different tools: King's College Criteria, ALFSG Prognostic Index.

Laboratory quality dependence: INR variability between laboratories (due to different ISI thromboplastin reagents) affects MELD calculation. UNOS recommends using labs with ISI close to 1.0.

Medical Disclaimer

MELD score calculation and interpretation must be performed by qualified hepatologists, transplant physicians, or gastroenterologists. Liver transplant evaluation involves multidisciplinary assessment beyond MELD score alone. Never use MELD score in isolation for transplant listing decisions.

References & Citations

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. PMID: 11172350 | DOI: 10.1053/jhep.2001.22172
Kim WR, Biggins SW, Kremers WK, et al.. “Hyponatremia and mortality among patients on the liver-transplant waiting list”. New England Journal of Medicine. 2008. 359(10): 1018–1026. PMID: 18768945 | DOI: 10.1056/NEJMoa0801209
Kim WR, Mannalithara A, Heimbach JK, et al.. “MELD 3.0: The Model for End-Stage Liver Disease Updated for the 21st Century”. Hepatology. 2021. 74(4): 1stipulated–1965. PMID: 34289133 | DOI: 10.1002/hep.32006
European Association for the Study of the Liver (EASL). “EASL Clinical Practice Guidelines on the management of liver diseases 2021”. Journal of Hepatology. 2021. 75(3): 659–703. DOI: 10.1016/j.jhep.2021.01.029

Medically Reviewed

Reviewed by CliniqWise Clinical Advisory Board — Hepatology & Transplant Medicine Panel · Last updated: 2026-08-27 · Next review: 2027-02-27

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