PELD Score Calculator
PELD Score Calculator
The Paediatric End-Stage Liver Disease score for candidates under 12 — bilirubin, INR, albumin, age under one year and growth failure. Not MELD with smaller numbers: a different model with a different albumin term.
PELD score
Five terms, children under 12Bilirubin 6.0 mg/dL, INR 1.6, albumin 2.8 g/dL, listed under 1 year, no growth failure
Formula and the OPTN bounds
Albumin, bilirubin and INR below 1.0 are set to 1.0 · score floored at 6
- the albumin term is negative
- −0.687 × ln(albumin), so a low albumin pushes the score up. The original MELD has no albumin at all, and MELD 3.0 takes it as a (3.5 − albumin) difference rather than a logarithm
- 0.436 for age under 1 year
- assessed at listing and retained thereafter. Infants awaiting liver transplantation die faster than their laboratory values predict, and this term is the model’s correction for it
- 0.667 for growth failure
- height or weight more than two standard deviations below the mean for age and sex. Failure to grow is a direct measure of how long and how badly the liver disease has been interfering with nutrition, and it has no adult equivalent
- the ×10 and the two coefficient sets
- the terms are multiplied by ten at the end. Some reproductions pre-multiply and quote 4.80, 18.57, −6.87, +4.36 and +6.67 instead. Mixing them gives a score a tenth or ten times its true value
- no ceiling
- OPTN states a minimum of 6 but no maximum in the policy text read for this page. A severely ill infant can compute above 40, which no MELD can, so comparing a high PELD with a MELD of 40 is not comparing like with like
- which children
- candidates registered under 12 years of age; from 12 upward the MELD family is used. That boundary is a registration rule, not a statement about biology
Worked example
Bilirubin 6.0 mg/dL, INR 1.6, albumin 2.8 g/dL, listed under 1 year, no growth failure
No value is below the floor of 1.0, so all three enter unchanged
0.480 × ln(6.0) = 0.8600 · 1.857 × ln(1.6) = 0.8728 · −0.687 × ln(2.8) = −0.7073 · age under 1 adds 0.436
Sum 1.4615 × 10 = 14.6149 → PELD 15
Turn the age term off — the same child listed at 13 months — and the sum falls to 1.0255, giving PELD 10. Five points for one date
Leave the age term off and add growth failure instead: 1.0255 + 0.667 = 1.6925 → PELD 17. Put both back and the sum is 2.1285 → PELD 21
In SI: bilirubin 102.6 µmol/L and albumin 28 g/L give the same 15
A much sicker infant — bilirubin 20 mg/dL, INR 3.0, albumin 2.0 g/dL, under one year, growth failure — computes to 41, above the ceiling every MELD variant has
PELD against the adult scores it is ranked beside
| PELD | MELD (original) | MELD 3.0 | |
|---|---|---|---|
| Who | Registered under 12 years | 12 and over | 18 and over at registration |
| Bilirubin | 0.480 × ln | 3.78 × ln | 4.56 × ln, with a sodium interaction |
| INR | 1.857 × ln | 11.2 × ln | 9.09 × ln |
| Albumin | −0.687 × ln | — | 1.85 × (3.5 − albumin), with a creatinine interaction |
| Creatinine | — (not in the original PELD) | 9.57 × ln, capped 4.0 | 11.14 × ln, capped 3.0 |
| Paediatric terms | Age under 1, growth failure | — | — |
| Floor / ceiling | 6 / none stated | 6 / 40 | 6 / 40 |
What each term is worth, at the worked example’s values
| Term | Contribution before ×10 | In PELD points |
|---|---|---|
| 0.480 × ln(bilirubin 6.0) | +0.8600 | +8.6 |
| 1.857 × ln(INR 1.6) | +0.8728 | +8.7 |
| −0.687 × ln(albumin 2.8) | −0.7073 | −7.1 |
| Age under 1 year at listing | +0.4360 | +4.4 |
| Growth failure | +0.0000 (absent here) | +0.0 |
| Total | +1.4615 | 14.6 → 15 |
Not MELD for children: a different model with different terms
PELD was developed in the Studies of Pediatric Liver Transplantation registry — 779 children in the analysis reported by the SRTR’s later refit — to do for paediatric candidates what MELD does for adults, and it is a genuinely different model rather than a rescaling. It has no creatinine term. It has an albumin term, which the original MELD does not. And it has two categorical terms with no adult equivalent: a point allowance for being listed under one year of age, and another for growth failure, defined as a height or weight more than two standard deviations below the mean. In the SRTR analysis the original model reached an area under the curve of 0.92 for death within 90 days of listing in its own derivation data, falling to 0.799 for 180-day mortality in a modern validation cohort of 5,111 listings.
That fall is why it was replaced. The United States moved from PELD to PELD-Cr in 2023, adding creatinine — capped at 1.3 mg/dL rather than the adult 3.0 — and re-estimating every coefficient. This page implements the original PELD, which is what the pre-2023 paediatric literature is written in and what a reader comparing against an older cohort needs. It is not the score a US transplant centre is allocating on today, and the page says so rather than letting the reader assume.
The two categorical terms are where PELD is most often computed wrongly, and the error is systematic rather than random. Both are assessed at listing and carried forward: a child registered at ten months keeps the age term after their first birthday, and a growth-failure assessment is not re-derived from today’s weight. Between them they are worth eleven points at the worked example’s values, so a PELD recalculated from a fresh blood result alone — which is the natural thing to do — comes out far too low.
The third thing to know is that the albumin coefficient is negative, so a falling albumin raises the score, and that OPTN’s floor of 1.0 on albumin therefore limits how much a very low albumin can contribute. Unlike every MELD variant, PELD has no published ceiling: a severely ill infant can compute above 40. Comparing such a number with an adult MELD of 40 is not comparing like with like. A score is not a diagnosis and a risk derived from a cohort is not a probability for one patient. This states what the number predicted in a named study; the clinician in front of the patient decides what follows.
Frequently asked questions
What is the PELD score and who is it for?
The Paediatric End-Stage Liver Disease score, for liver transplant candidates registered under 12 years of age. It takes bilirubin, INR and albumin, plus two categorical terms: being listed under one year old, and growth failure. From 12 years upward the MELD family is used instead.
Is PELD just MELD for children?
No. PELD has no creatinine term, has an albumin term the original MELD lacks, and carries two paediatric-specific terms with no adult counterpart. The coefficients differ entirely from MELD 3.0‘s, and so does the scale at the top: PELD has no published ceiling, while every MELD is capped at 40. The Child-Pugh score is the other instrument used alongside it in children.
What counts as growth failure for PELD?
A height or a weight more than two standard deviations below the mean for age and sex — a Z-score below −2 on either measure. It is assessed at listing and carried forward, not recomputed each time the laboratory values change.
Does the age-under-1 term drop off when the child turns one?
No. It is assessed at the time of listing and retained. A child registered at ten months keeps the 0.436 term afterwards. It is worth about 4.4 PELD points, so dropping it on a birthday is a substantial and entirely avoidable error.
Is PELD still used for allocation?
Not in the United States. OPTN replaced PELD with PELD-Cr in 2023, adding creatinine — capped at 1.3 mg/dL — and sodium, and re-estimating the coefficients. PELD-Cr’s coefficient table lives in OPTN policy and is not reproduced or approximated here. This page computes the original PELD.
Related calculators
References
- Hsu EK, Schladt DP, Wey A, et al. Improving the predictive ability of the Pediatric End-Stage Liver Disease score for young children awaiting liver transplant. Am J Transplant. 2021;21(1):222–8.
- McDiarmid SV, Anand R, Lindblad AS; SPLIT Research Group. Development of a pediatric end-stage liver disease score to predict poor outcome in children awaiting liver transplantation. Transplantation. 2002;74(2):173–81.
- OPTN. Policy Guidance: Improving Liver Allocation — MELD, PELD, Status 1A and Status 1B. Organ Procurement and Transplantation Network, 2023.
- OPTN Liver and Intestinal Organ Transplantation Committee. Improving Liver Allocation: MELD, PELD, Status 1A and Status 1B — briefing paper and public comment proposal, Winter 2022.
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/