UKELD Score Calculator
UKELD Score Calculator
The United Kingdom End-Stage Liver Disease score — INR, creatinine, bilirubin and sodium in SI units, with no clamping anywhere, and a listing threshold of 49 for adults without hepatocellular carcinoma.
UKELD score
Four labs, SI units, no capsINR 1.3, creatinine 90 µmol/L, bilirubin 50 µmol/L, sodium 137 mmol/L, constant 435.4
Formula
No floor, no cap, no bound on any input
- SI units, not mg/dL
- creatinine and bilirubin in µmol/L — the opposite convention to every MELD variant. Entering mg/dL values unconverted gives a UKELD about 15 points too low. Multiply a mg/dL bilirubin by 17.104 and a mg/dL creatinine by 88.4
- −81.565 on ln(sodium)
- by far the largest coefficient in the equation, and the reason UKELD is sometimes described as a hyponatraemia score with three other terms attached. A fall from 137 to 130 mmol/L adds about 4.3 points; MELD-Na would add rather less and MELD nothing at all
- no clamping
- neither source read for this page states a floor or a cap, and the transplantr implementation applies none. An INR below 1.0 lowers the score, a creatinine of 600 µmol/L keeps raising it, and a sodium of 120 is used as 120
- 435.4 or 435
- the Experimental and Clinical Transplantation 2021 full text prints 435.4; the transplantr R package and most secondary reproductions use 435. Barber’s 2011 derivation paper could not be reached to settle it, so both are offered above. The gap is 0.4 of a point
- 49
- the minimum UKELD for registration on the UK elective adult list without hepatocellular carcinoma, corresponding to a predicted one-year waiting-list mortality of about 9%. UK policy also lists variant syndromes in which a patient may be registered below it
Worked example
INR 1.3, creatinine 90 µmol/L, bilirubin 50 µmol/L, sodium 137 mmol/L, constant 435.4
5.395 × ln(1.3) = 1.4155 · 1.485 × ln(90) = 6.6822 · 3.13 × ln(50) = 12.2446
−81.565 × ln(137) = −401.2992 · constant +435.4
Total 54.4, above the listing threshold of 49
Switch the constant to 435 and the answer is 54.0 — the whole of the published disagreement, in one step
Drop the sodium to 130 and UKELD rises to 58.7. The same 7 mmol/L fall changes MELD not at all, because MELD has no sodium term
Enter the same patient in conventional units — bilirubin 2.92 mg/dL, creatinine 1.02 mg/dL — and the answer is the same 54.4. Enter 2.92 and 1.02 with the unit left on SI and UKELD collapses to 38.9, 15.5 points low and comfortably below the listing threshold. That is the error this selector exists to prevent
UKELD and the MELD family: what is bounded and what is not
| UKELD | MELD (original) | MELD 3.0 | |
|---|---|---|---|
| Units | µmol/L | mg/dL | mg/dL |
| Lower bound on labs | None | 1.0 on all three | 1.0 on bilirubin, INR, creatinine |
| Creatinine cap | None | 4.0 mg/dL | 3.0 mg/dL |
| Sodium | ln term, coefficient −81.565, unbounded | Not used | Bounded 125–137 mmol/L |
| Dialysis rule | None stated | Creatinine set to 4.0 | Creatinine set to 3.0 |
| Score floor / ceiling | None | 6 / 40 | 6 / 40 |
| Threshold in use | 49 for elective listing | 15 as a transplant-benefit figure | Continuous allocation |
How far each input moves UKELD
| Change from the worked example | UKELD | Change |
|---|---|---|
| Worked example (INR 1.3, Cr 90, bili 50, Na 137) | 54.4 | — |
| Sodium 130 instead of 137 | 58.7 | +4.3 |
| Sodium 125 instead of 137 | 61.9 | +7.5 |
| Bilirubin 100 instead of 50 | 56.6 | +2.2 |
| Creatinine 180 instead of 90 | 55.5 | +1.0 |
| INR 2.0 instead of 1.3 | 56.8 | +2.3 |
The UK score, in SI units, with nothing clamped
UKELD was derived from the UK elective liver transplant waiting list to answer a question MELD was not built for: which adults are sick enough that transplantation offers them a survival benefit, in a system with its own donor supply and its own waiting-list mortality. It takes the same three laboratory values as MELD and adds sodium, and NHS Blood and Transplant policy uses a UKELD of 49 — corresponding to a predicted one-year waiting-list mortality of about 9% — as the minimum for registration on the elective adult list for a candidate without hepatocellular carcinoma.
Two things about it will trip up a reader who comes to it from MELD. The first is units: UKELD’s creatinine and bilirubin are in µmol/L, which is the opposite convention to every MELD variant, and typing mg/dL values in unconverted produces a score about fifteen points too low — low enough to look like a well patient. The second is that UKELD clamps nothing. There is no floor of 1.0, no creatinine cap, no sodium window of 125 to 137, and no score ceiling. An INR below 1.0 lowers the score; a creatinine of 600 µmol/L keeps raising it; a sodium of 118 is used as 118.
That second difference is not a technicality. Because the sodium coefficient is −81.565, far larger than anything else in the equation, and because it is unbounded, UKELD responds to hyponatraemia much more strongly than MELD-Na or MELD 3.0 do — both of which stop counting below 125 mmol/L. A fall from 137 to 130 is worth about 4.3 UKELD points. The small numerical range of a serum sodium is misleading: the logarithm barely moves, but the coefficient makes that movement count for more than doubling the bilirubin does.
The constant is the one place the published sources disagree. One journal full text prints 435.4 and the widely used transplantr implementation uses 435; the derivation paper could not be read from here to adjudicate, so both are offered above and neither is reconciled silently. The gap is 0.4 of a point, which is invisible except for a patient scoring between 48.6 and 49.0. Where UKELD is the number that decides a listing criterion, use the figure your transplant unit’s own calculator returns. 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 UKELD formula?
UKELD = 5.395 × ln(INR) + 1.485 × ln(creatinine in µmol/L) + 3.13 × ln(bilirubin in µmol/L) − 81.565 × ln(sodium in mmol/L) + 435.4. Note the SI units and the constant: some reproductions use 435 instead of 435.4, a difference of 0.4 of a point.
What UKELD score is needed for liver transplant listing in the UK?
A UKELD of 49 or above is the minimum for registration on the UK elective adult list for a candidate without hepatocellular carcinoma. UK policy also recognises variant syndromes — intractable pruritus, diuretic-resistant ascites, recurrent cholangitis, hepatopulmonary syndrome — in which a patient may be registered below it.
Why does UKELD change so much with sodium?
Because the sodium coefficient is −81.565, much the largest in the equation, and because UKELD does not bound sodium the way MELD-Na and MELD 3.0 bound it to 125–137 mmol/L. A fall from 137 to 130 adds about 4.3 UKELD points — more than doubling the bilirubin.
Does UKELD cap creatinine like MELD does?
No. Neither source read for this page states any floor or cap on any UKELD input, and the standard implementation applies none. A creatinine of 600 µmol/L keeps contributing, where MELD stops above 4.0 mg/dL. There is also no dialysis rule and no score ceiling of 40.
Can I convert a MELD into a UKELD?
No, and attempting it is the error worth avoiding. UKELD and MELD share three inputs but use different units, different coefficients, different bounding and a different scale, and UKELD carries a sodium term the original MELD does not — MELD-Na and MELD 3.0 do, but bounded. Compute each from the laboratory values.
Related calculators
References
- Barber KM, Madden S, Allen J, Collett D, Neuberger J, Gimson A. Elective liver transplant list mortality: development of a United Kingdom end-stage liver disease score. Transplantation. 2011;92(4):469–76.
- Dogan N, et al. Prognostic scores in liver transplant candidates. Exp Clin Transplant. 2021;19(6):570 (open access).
- Neuberger J, Gimson A, Davies M, et al. Selection of patients for liver transplantation and allocation of donated livers in the UK. Gut. 2008;57(2):252–7.
- Scottish Liver Transplant Unit. Assessment Protocol for Liver Transplantation. NHS Lothian, 2020.
- Asher J. transplantr: Audit and Research Functions for Transplantation — R package source, liver recipient scoring (meld, meld_na, ukeld, peld).
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/