MELD 3.0 Score Calculator
MELD 3.0 Score Calculator
Calculate the MELD 3.0 score used for liver transplant allocation, including the sex and albumin terms added in the 2023 revision.
MELD 3.0 Score
6 inputs → 6–40Male, bilirubin 3.2, INR 1.8, creatinine 1.6, sodium 132, albumin 3.0, no dialysis
Formula
- female
- 1 for female, 0 for male
- bilirubin
- mg/dL, floored at 1.0
- INR
- floored at 1.0
- creatinine
- mg/dL, bounded 1.0–3.0; set to 3.0 on dialysis
- sodium
- mmol/L, bounded 125–137
- albumin
- g/dL, bounded 1.5–3.5
- result
- rounded, then bounded 6–40
Worked example
Male, bilirubin 3.2, INR 1.8, creatinine 1.6, sodium 132, albumin 3.0, no dialysis
Bounded values: bilirubin 3.2, INR 1.8, creatinine 1.6, sodium 132, albumin 3.0
4.56×ln(3.2)=5.304 · 0.82×5=4.100 · −0.24×5×ln(3.2)=−1.396
9.09×ln(1.8)=5.343 · 11.14×ln(1.6)=5.236 · 1.85×0.5=0.925 · −1.83×0.5×ln(1.6)=−0.430 · +6
Total 25.08 → MELD 3.0 = 25. The same values in a woman give 26.
What changed in MELD 3.0
| Change | Reason |
|---|---|
| Added a female sex term (+1.33) | MELD-Na systematically underestimated mortality in women, partly through creatinine and lower muscle mass |
| Added albumin, and an albumin×creatinine interaction | Improved discrimination, particularly at lower creatinine values |
| Creatinine upper bound lowered to 3.0 | Was 4.0 in MELD-Na |
| Bilirubin×sodium interaction retained | From MELD-Na |
What the score is for
MELD began as a predictor of survival after a transjugular intrahepatic portosystemic shunt and became the basis of liver allocation because it does something unusual: it ranks patients by how likely they are to die in the next 90 days without transplant, using only objective laboratory values that cannot be gamed by clinical judgement.
MELD 3.0 is the 2023 revision. Its most consequential change is the sex term. Women were disadvantaged under the previous formula because creatinine, one of the strongest components, reflects muscle mass as well as renal function, and lower muscle mass produced a lower creatinine at the same degree of renal impairment. The result was that women waited longer and died on the list more often. The explicit +1.33 for female sex, together with the albumin terms, narrows that gap.
The score is not a diagnosis of severity in isolation. It deliberately ignores complications such as refractory ascites, encephalopathy and hepatocellular carcinoma, which are handled separately through exception points. And because it is driven by three labile laboratory values, it is recalculated frequently — a patient’s position on a waiting list can change within days.
Frequently asked questions
What is the difference between MELD 3.0 and MELD-Na?
MELD 3.0 adds a term for female sex and two albumin terms, lowers the creatinine cap from 4.0 to 3.0, and uses a different constant. It replaced MELD-Na for United States allocation in July 2023.
Why does MELD 3.0 include sex?
Creatinine reflects muscle mass as well as kidney function, so women with the same renal impairment scored lower and were disadvantaged in allocation. The +1.33 term corrects for the observed mortality difference.
What happens to creatinine on dialysis?
It is set to 3.0 mg/dL if the patient has had dialysis at least twice in the past week, or 24 hours of continuous veno-venous haemodialysis.
What is a dangerous MELD score?
Above 20 indicates high 90-day mortality without transplant, and above 30 very high. Below 15, transplant is generally not expected to improve survival over remaining listed.
Does MELD 3.0 apply to children?
No. It is for candidates aged 12 and over. Children under 12 are scored with PELD.
Related calculators
References
- Kim WR et al. MELD 3.0: the model for end-stage liver disease updated for the modern era. Gastroenterology. 2021;161(6):1887–95.
- OPTN/UNOS policy — MELD 3.0 implementation, July 2023.
- University of Washington Hepatitis C Online — MELD 3.0 clinical calculator.