MELD Score Calculator – With MELD-Na
Three ordinary lab results, turned into a single number from 6 to 40.
The lab results
Results update live as you type. Calculate re-runs the same calculation and jumps to the score.
🔒 Everything is calculated in your browser — nothing you enter leaves your device. Lab results are personal health information; they are never sent anywhere by this page.
The score
How the score is built
Reading a MELD-Na of 21
This score sits in the 20–29 band. In the studies the score was built on, about 19.6 percent of patients in this band died within three months without a transplant — the figure that made MELD a fairer way to queue for a scarce organ than waiting time alone. Those percentages describe groups of patients from past studies, never one person’s future: your own picture depends on far more than three lab values, and your care team reads the score alongside everything else.
Advanced options — MELD 3.0, the current US allocation score
These extra readouts are worked out live from the labs above — open Advanced options to see MELD 3.0, the score used for liver allocation in the United States since 13 July 2023. Add albumin and sex below; the panel reads bilirubin, INR, creatinine, sodium and the dialysis tick from the main calculator. The main MELD and MELD-Na scores above never change.
MELD 3.0 working appears here once the labs above and albumin are valid.
Band reading: 10–19 — about 6.0% of patients in this band died within three months without a transplant in the classic validation studies. Band figures are group history, not a personal prognosis.
- Albumin 3.5 sits at the 3.5 ceiling, so the albumin terms add nothing here.
- Sodium 130 counts 7 points below the 137 ceiling.
Formula: Kim et al., MELD 3.0, Gastroenterology 2021, as adopted in OPTN liver allocation policy from 13 July 2023. Scope: adult candidates (18 or older). Candidates registered before age 18 use a variant with constant 7.33 and no sex term — this panel does not compute that variant. This is an educational estimate, never the official score on a transplant file, which the centre calculates from verified labs.
The MELD score turns three ordinary lab results — bilirubin, INR and creatinine — into a single number from 6 to 40 that grades how urgently a failing liver needs a transplant. This calculator does the whole official calculation, not a shortcut version: the value floors, the creatinine cap, the dialysis rule, the rounding, and the MELD-Na sodium adjustment that only switches on when the score passes 11 — each one shown in the working, so you can check every step against the lab report in your hand.
Key takeaways
- Classic MELD uses three labs — bilirubin, INR and creatinine — with floors at 1.0, a creatinine cap at 4.0, and the dialysis rule setting creatinine to 4.0.
- MELD-Na adds sodium only when MELD is above 11, with sodium clamped between 125 and 137; MELD 3.0 adds albumin and female sex, always counts sodium, and caps creatinine at 3.0 instead.
- Every score is an estimate from group data: the 90-day percentages describe past patient groups, never one person’s future, and only a transplant centre’s official score counts for allocation.
Contents
Where the score sits
MELD runs from 6, the lowest score the formula can give, to 40, the cap. The bands below are the ones used in the original validation studies, with the share of patients in each band who died within three months without a transplant.
The dark marker is the MELD score; the orange marker is MELD-Na when sodium counts. The percentages are three-month mortality without a transplant, from the studies the score was validated in — group history, not a prediction about any individual.
Why a formula decides who gets a liver
There are never enough donor livers. Before MELD, organs in the United States were allocated largely by waiting time and a partly subjective grading — a system that could leave the sickest patients waiting behind people stable enough to wait at home. MELD replaced that with three measurable lab values and a published formula, so that the order of the queue follows how likely someone is to die without a transplant. That is the whole idea of the score: not a diagnosis, not a treatment guide — a fair queue, written in arithmetic anyone can check. This page exists so you can check it.
Pairs well with this calculation
Creatinine does double duty in medicine — these two read the same lab through the kidney lens, and BMI is the body-size figure that appears all over clinical scoring.
GFR Calculator
Estimated glomerular filtration rate — how well the kidneys filter, from the same creatinine.
Creatinine Clearance Calculator
The Cockcroft–Gault estimate of kidney function, worked out step by step.
BMI Calculator
Body mass index from height and weight — the other number on almost every chart.
The MELD score in three steps
Enter the three labs
Total bilirubin and creatinine in mg/dL (or switch to µmol/L), plus the INR. Add serum sodium if you have it — that is what turns MELD into MELD-Na — and tick the dialysis box if it applies, because it changes how creatinine counts.
Apply the floors and caps
Before any maths, the official rules adjust the labs: any value below 1.0 is raised to 1.0, creatinine is capped at 4.0, and dialysis in the past week sets creatinine to 4.0 outright. These rules stop small lab quirks from swinging a life-and-death score.
Log, weight, round
Each adjusted lab is logged, multiplied by its weight — INR counts most, at 11.2 — and added to the constant 6.43. The total is rounded to the nearest whole number and held inside 6 to 40. If that score is above 11 and sodium was entered, the sodium adjustment runs last.
MELD 3.0: the score US allocation uses now
If you are listed for a liver transplant in the United States today, the number that decides your place in the queue is not the classic MELD on the main calculator, and not MELD-Na either. Since 13 July 2023, US allocation has used MELD 3.0, a refitted formula published by Kim and colleagues in 2021. It keeps the same idea — objective labs, a published formula, sickest first — but it fixes two weaknesses the old formula had lived with for twenty years, and it reweights everything else in the light of modern data.
MELD 3.0 = 1.33 (if female) + 4.56 × ln(bilirubin) + 0.82 × (137 − Na) − 0.24 × (137 − Na) × ln(bilirubin) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5 − albumin) − 1.83 × (3.5 − albumin) × ln(creatinine) + 6
The two genuinely new inputs are albumin and sex. Albumin is the main protein the liver makes, so a falling albumin is a direct read on how much synthetic function the liver has left; the formula rewards a healthy albumin of 3.5 with nothing and adds points as albumin falls toward the 1.5 floor. Sex enters as a flat 1.33 points for female candidates. That is not a favour handed out for its own sake. Under the old formula, women were scored systematically lower than equally sick men, largely because creatinine — the kidney marker — runs lower in people with less muscle mass, and the old formula had no way to know why a creatinine was low. The 1.33 points correct that gap, and the refit also changed the creatinine cap, from 4.0 down to 3.0, because in modern data a creatinine above 3.0 added almost no extra predictive information.
The two interaction terms are the subtlest part of the refit, and the reason MELD 3.0 cannot be approximated by adding a few points to MELD-Na. The first, −0.24 × (137 − Na) × ln(bilirubin), means sodium matters less when bilirubin is very high: a patient already desperately ill by bilirubin does not gain as much from a low sodium as a patient with a modest bilirubin does. The second, −1.83 × (3.5 − albumin) × ln(creatinine), works the same way for albumin and creatinine: when both are bad, each one counts slightly less than it would alone. Interactions like these are what a refit on hundreds of thousands of waitlist records can see and a hand-built formula cannot.
The default labs, worked through MELD 3.0. Bilirubin 2.0, INR 1.5, creatinine 1.2, sodium 130, albumin 3.5, male. Bilirubin: 4.56 × ln(2.00) = 3.16. Sodium: 0.82 × 7 = 5.74. The bilirubin–sodium interaction: −0.24 × 7 × ln(2.00) = −1.16. INR: 9.09 × ln(1.50) = 3.69. Creatinine: 11.14 × ln(1.20) = 2.03. Albumin sits at the 3.5 ceiling, so both albumin terms are zero. Add the constant 6: 3.16 + 5.74 − 1.16 + 3.69 + 2.03 + 0 + 0 + 6 = 19.45, rounding to MELD 3.0 of 19. For a female candidate with identical labs, add 1.33: 20.78, rounding to 21 — the same number MELD-Na gives here, by coincidence, not by construction. Change any lab and the two scores will diverge, because their weights, caps and interaction terms all differ.
How much better is the refit? In the MELD 3.0 validation data, the score predicted death within 90 days with a concordance statistic of 0.8693, against 0.8622 for MELD-Na — a modest numerical gain that was nonetheless statistically significant, and one that came with the fairness gain for women that the old formula could never deliver. Two scope limits matter. First, this panel computes the adult formula, for candidates 18 or older; candidates registered before age 18 use a variant with a constant of 7.33 and no sex term, which this panel deliberately does not compute. Second, MELD 3.0 is the US allocation score, not a universal one: much of the world and most of the research literature still report classic MELD or MELD-Na, which is why this page keeps all three side by side instead of replacing the old scores.
| Term | Coefficient | What it does |
|---|---|---|
| Female sex | +1.33 if female | Corrects the old formula’s under-scoring of women; adult candidates only. |
| Bilirubin | 4.56 × ln(bilirubin) | Liver clearance; floored at 1.0 mg/dL. |
| Sodium | 0.82 × (137 − Na) | Always counts in MELD 3.0 — no above-11 gate, unlike MELD-Na; clamped 125–137. |
| Bilirubin–sodium interaction | −0.24 × (137 − Na) × ln(bilirubin) | Sodium counts less when bilirubin is very high. |
| INR | 9.09 × ln(INR) | Clotting-factor production; floored at 1.0. |
| Creatinine | 11.14 × ln(creatinine) | Kidney function; floored at 1.0, capped at 3.0, set to 3.0 on dialysis. |
| Albumin | 1.85 × (3.5 − albumin) | Liver synthetic function; clamped 1.5–3.5 g/dL. |
| Albumin–creatinine interaction | −1.83 × (3.5 − albumin) × ln(creatinine) | Each counts slightly less when both are bad. |
| Constant, then round and cap | +6, round, hold 6–40 | Same 6–40 scale as every MELD version. |
Source: Kim et al., MELD 3.0, Gastroenterology 2021 (formula, bounds and validation concordance); OPTN liver allocation policy in effect from 13 July 2023 (US adoption date).
The OPTN floors, caps and clamps, all in one place
Every MELD version adjusts the labs before any logarithms are taken, and the adjustments are part of the score, not rounding conveniences. A calculator that skips them will disagree with a transplant centre’s arithmetic on exactly the patients where the score matters most — the very sick and the nearly well. Here is the full set, classic MELD and MELD 3.0 side by side, so you can check any lab set by hand.
The floors exist because of the logarithm. The log of a number below 1 is negative, so without a floor a superb lab value would subtract points — the maths would reward a bilirubin of 0.4 as if it predicted better survival than a bilirubin of 1.0, which the outcome data never supported. So every lab that enters through a log is raised to 1.0 first: bilirubin, INR and creatinine in both versions. Sodium and albumin are not logged, so they get clamps instead of floors: sodium is held between 125 and 137 in both versions, and albumin between 1.5 and 3.5 in MELD 3.0. A sodium of 120 counts as 125, a sodium of 142 counts as 137, an albumin of 1.1 counts as 1.5, and an albumin of 4.2 counts as 3.5. The clamp is silent in the main calculator’s notes only when it actually bites — type a sodium of 120 and the notes will tell you it was treated as 125.
Creatinine carries the most rules because it is the least trustworthy lab of the set. It moves with muscle mass, diet and the assay a laboratory runs, and dialysis lowers it without making the patient any less sick. Classic MELD caps it at 4.0 and sets it to 4.0 outright for anyone dialysed at least twice in the past week or given 24 hours of continuous venovenous haemofiltration. MELD 3.0 does the same job with a lower cap: 3.0, and dialysis sets it to 3.0. That single difference — 4.0 versus 3.0 — is why a dialysis patient’s classic MELD and MELD 3.0 can differ by more than the albumin and sex terms alone would suggest, and why the Advanced panel reads the dialysis tick from the main calculator rather than asking you twice. The final steps are identical in both versions: sum the weighted logs unrounded, round once to the nearest whole number, and hold the result between 6 and 40. MELD-Na adds one more rule of its own: its sodium adjustment runs only when the rounded classic MELD is above 11, and it starts from that rounded score, not the raw one.
| Lab | Classic MELD / MELD-Na | MELD 3.0 |
|---|---|---|
| Bilirubin (mg/dL) | Floored at 1.0; no cap | Floored at 1.0; no cap |
| INR | Floored at 1.0 | Floored at 1.0 |
| Creatinine (mg/dL) | Floored at 1.0, capped at 4.0; dialysis sets it to 4.0 | Floored at 1.0, capped at 3.0; dialysis sets it to 3.0 |
| Sodium (mmol/L) | Clamped 125–137; counts only when MELD is above 11 | Clamped 125–137; always counts |
| Albumin (g/dL) | Not used | Clamped 1.5–3.5 |
| Sex | Not used | +1.33 if female (adult candidates) |
| Final score | Round once, hold 6–40 | Round once, hold 6–40 |
One worked clamp example, using the page’s own “Everything low” preset: bilirubin 0.5, INR 0.8, creatinine 0.4, sodium 128. All three logged labs sit below the 1.0 floor, so all three count as 1.0, every log term is zero, and the raw score is just the constant, 6.43, rounding to a MELD of 6 — the floor of the whole scale. Sodium does not rescue it: classic MELD-Na ignores sodium at a MELD of 6, because the score is not above 11. MELD 3.0 behaves differently on the same labs, because it has no above-11 gate: sodium 128 contributes 0.82 × 9 = 7.38 even with perfect other labs, giving a raw 13.38 and a MELD 3.0 of 13 for a male candidate with albumin 3.5. That is not a contradiction and not an error — it is the refit saying that a low sodium on its own carries risk, even when the liver labs look fine.
90-day mortality by score band
A MELD score is most often quoted next to a percentage: the share of patients at that score who died within three months without a transplant. Those percentages come from the validation studies the score was built on, and they are the reason the score is trusted for ranking a queue. They are also the most misread numbers on this page, so read the framing with the table, not just the table.
| Score band | 90-day mortality without transplant | 90-day survival | How to read it |
|---|---|---|---|
| 6–9 | 1.9% | 98.1% | Lowest band; most patients here are managed without urgent listing. |
| 10–19 | 6.0% | 94.0% | The band where sodium starts to matter and transplant evaluation typically begins — benefit of transplant generally exceeds operative risk from around 15. |
| 20–29 | 19.6% | 80.4% | Risk climbs steeply; scores here move patients well up the list. |
| 30–39 | 52.6% | 47.4% | More than half of patients in this band died within three months in the original studies. |
| 40 | 71.3% | 28.7% | The cap; the formula stops here however extreme the labs run. |
The default labs on this page give a MELD-Na of 21, which sits in the 20–29 band: in the validation studies, about 19.6% of patients in that band died within three months without a transplant, and about 80.4% survived that window. That sentence is about a group of past patients who shared a score band, not about the person whose labs produced the 21. Two people with the same score can have very different prospects, because MELD counts only a handful of labs: it knows nothing about infection, bleeding, frailty, other organs, or how fast the labs are changing, and it knows nothing about exception points, blood type or geography, which decide real allocation. Bands are also coarse by design — a score of 20 and a score of 29 share a band but not a risk, and the underlying risk rises smoothly with the score rather than jumping at band edges. Use the band to understand the scale of urgency, never as a verdict on one person, and never as a reason to change any treatment: questions about a real score belong with the care team, who see the whole picture.
One more honesty note: these band figures are the published classic-MELD validation figures, reproduced in OPTN and UNOS registry studies. MELD 3.0 refits individual risk, so its exact 90-day risk at a given score differs slightly from the classic band figure. The Advanced panel therefore maps a MELD 3.0 score to the same bands as an approximate reading and says so on the panel, rather than inventing a separate MELD 3.0 band table the published literature does not supply in this form.
Reading the three scores side by side
This page now reports three numbers from one set of labs. They are not three opinions about the same thing, and they are not interchangeable — each one belongs to a different era and a different job.
| Classic MELD | MELD-Na | MELD 3.0 | |
|---|---|---|---|
| Inputs | Bilirubin, INR, creatinine | Classic MELD plus sodium | Bilirubin, INR, creatinine, sodium, albumin, sex |
| Creatinine cap / dialysis | 4.0 / 4.0 | 4.0 / 4.0 | 3.0 / 3.0 |
| Sodium rule | Not used | Clamped 125–137, only when MELD is above 11 | Clamped 125–137, always |
| Where it counts | Research and much of the world outside current US allocation | US allocation 2016 to July 2023; still widely quoted | US liver allocation since 13 July 2023 |
| Default labs on this page | 15 | 21 | 19 (male, albumin 3.5); 21 (female) |
The timeline explains why all three survive. MELD itself was developed around 2000 to predict survival after TIPS procedures, and the United States adopted it for liver allocation in 2002, replacing a system that leaned on waiting time and partly subjective grading. In 2016, MELD-Na added sodium, after studies showed low sodium predicted death independently of the three original labs. In July 2023, MELD 3.0 replaced MELD-Na for US allocation, adding albumin and female sex, lowering the creatinine cap, and refitting every coefficient. If you are reading a study from 2019, its MELD-Na scores are the right lens; if you are listed in the United States today, MELD 3.0 is the number on your file; if you are comparing scores across countries or eras, classic MELD is the common language. When the three disagree — and on sick patients they often disagree by several points — none of them is “wrong”. They are different formulas answering slightly different questions, and the one that matters for allocation is the one your system currently uses, calculated by your centre from verified labs.
Worked examples beyond the default
The page’s four example presets are not decoration — each one isolates a rule. Worked here by hand, so you can check the calculator against arithmetic rather than trusting it.
Everything low: bilirubin 0.5, INR 0.8, creatinine 0.4, sodium 128. All three logged labs fall below the 1.0 floor and count as 1.0, so every log term is zero and the raw score is the constant alone, 6.43, rounding to MELD 6. Sodium is ignored for MELD-Na because 6 is not above 11, so MELD-Na is also 6. MELD 3.0, with albumin 3.5 and male selected, is 13 — sodium alone contributes 7.38, because MELD 3.0 has no above-11 gate. The lesson is the gate itself: the same sodium moves one score by six points and the other by none.
On dialysis: bilirubin 3.0, INR 2.0, creatinine 2.0 with the dialysis tick, sodium 132. Dialysis sets creatinine to 4.0 for classic MELD, whatever the typed value. Bilirubin: 3.78 × ln(3.00) = 4.15. INR: 11.2 × ln(2.00) = 7.76. Creatinine: 9.57 × ln(4.00) = 13.27. Add 6.43: 31.61, rounding to MELD 32. Sodium 132 sits 5 below the ceiling: 32 + 1.32 × 5 − 0.033 × 32 × 5 = 32 + 6.60 − 5.28 = 33.32, rounding to MELD-Na 33. MELD 3.0 for the same labs, male with albumin 3.0, is 32: dialysis sets creatinine to 3.0 there, not 4.0, and the albumin term adds 0.93 while its interaction with creatinine subtracts 1.01 — the refit’s moving parts nearly cancelling on this particular set.
Severe labs: bilirubin 8.0, INR 2.6, creatinine 3.0, sodium 128. Bilirubin: 3.78 × ln(8.00) = 7.86. INR: 11.2 × ln(2.60) = 10.70. Creatinine: 9.57 × ln(3.00) = 10.51. Add 6.43: 35.51, rounding to MELD 36. Sodium 128 sits 9 below the ceiling: 36 + 1.32 × 9 − 0.033 × 36 × 9 = 36 + 11.88 − 10.69 = 37.19, rounding to MELD-Na 37, in the 30–39 band where the validation studies put 90-day mortality at 52.6%. MELD 3.0 for the same labs, male with albumin 2.8, is 39; for a female candidate it is 40.51 before the cap, which the 40 cap pulls back to 40. The cap is doing real work here: without it, the female severe score would print as 41, a number no allocation system recognises.
A unit-switch check. Switch the unit chips to µmol/L and the page converts the typed labs: bilirubin in µmol/L divides by 17.1 and creatinine by 88.4 before the formula runs, so a bilirubin of 34.2 µmol/L and a creatinine of 106.1 µmol/L are the same labs as the default 2.0 and 1.2 mg/dL, and must give the same scores. If they do not, something has been typed in the wrong unit — the commonest real-world MELD error, and the reason the unit chips convert the numbers you already typed instead of just relabelling them.
How the MELD score calculator works
MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43
The example on this page. Bilirubin 2.0, INR 1.5, creatinine 1.2 — all above the 1.0 floor, none capped. Bilirubin: 3.78 × ln(2.00) = 2.62. INR: 11.2 × ln(1.50) = 4.54. Creatinine: 9.57 × ln(1.20) = 1.74. Add the constant: 2.62 + 4.54 + 1.74 + 6.43 = 15.34, which rounds to a MELD of 15.
Then the sodium. The MELD of 15 is above 11, so MELD-Na applies. Sodium 130 sits 7 points under the 137 ceiling. The formula adds 1.32 × 7 = 9.24, then subtracts the interaction term, 0.033 × 15 × 7 = 3.46, which keeps the sodium effect shrinking as MELD itself grows: 15 + 9.24 − 3.46 = 20.78, rounding to a MELD-Na of 21. Low sodium is itself dangerous in liver disease — that is why it earns points.
Why INR carries the biggest weight. The coefficients are not opinions; they were fitted to real outcomes. In the data the formula was built from, a rising INR — blood losing its ability to clot as the liver fails to make clotting factors — predicted death more strongly than the other two labs, so it earned the largest multiplier, 11.2. Creatinine follows at 9.57, because kidney failure alongside liver failure is an ominous combination. Bilirubin, the yellow pigment the liver fails to clear, counts least per log point at 3.78.
Why logarithms? Risk does not rise in straight lines. Going from a bilirubin of 1 to 2 matters far more than going from 21 to 22, and the natural log builds exactly that shape in: each doubling of a lab adds the same number of points, wherever it starts. The log is also why the floor exists — the log of a value below 1 is negative, and without the floor a very good lab could drag a score down in a way the outcome data never supported.
How the numbers are rounded. Once, at the end. The labs are adjusted first, the weighted logs are summed unrounded, and only the total is rounded to the nearest whole number — then held between 6 and 40. For MELD-Na, the published sequence starts from that rounded MELD score, applies the sodium terms, and rounds again. Rounding in the middle would give different answers on different calculators; the fixed sequence is what keeps every centre’s arithmetic identical.
Going deeper
Each rule patches a known way the raw labs can mislead. The 1.0 floor exists because the formula uses logarithms: below 1, a log turns negative, so a patient with a superb bilirubin of 0.4 would be rewarded with points off — even though the outcome data showed no survival benefit down there. Setting every lab to at least 1.0 keeps the maths honest and stops laboratories’ slightly different reference ranges from moving scores.
Creatinine is the trickiest of the three labs. It rises and falls with muscle mass, diet and the specific assay a lab runs, and it can be lowered by dialysis without the patient being any less sick. The 4.0 cap stops an extreme creatinine from dominating the score entirely. The dialysis rule goes further: someone dialysed at least twice in the past week, or given 24 hours of continuous venovenous haemofiltration (CVVH), has creatinine set to 4.0 outright — because dialysis artificially cleans the blood, and without the rule those patients would be scored as far healthier than they are.
Doctors noticed early that two patients with the same MELD could fare very differently depending on their sodium. Low serum sodium in liver disease signals a circulation under real strain, and studies led by Kamath and others showed it predicted death independently of the three MELD labs. In January 2016 the US allocation system adopted MELD-Na: the formula on this page, where sodium — clamped between 125 and 137 — adjusts the score, but only once MELD passes 11, because at low scores it changed nothing that mattered.
The story did not stop there. In July 2023, US liver allocation moved to MELD 3.0, a refitted formula that adds albumin and female sex, updates the coefficients, and caps creatinine lower, at 3.0 — correcting, among other things, a long-recognised gap in which women were scored systematically lower than equally sick men. If you are listed in the United States today, your official allocation score is MELD 3.0, calculated by your transplant centre. The classic MELD and MELD-Na on this page remain the reference scores across much of the world and throughout the research literature — and they are the right lens for understanding a lab report, a study, or a score given outside the current US system.
MELD versus Child-Pugh: different questions
MELD is built from labs alone, which makes it objective and reproducible, but it has no term for ascites, encephalopathy, or frailty. Child-Pugh includes those clinical features and stages disease, which is why it still appears in clinic discussions. MELD prioritises organs; Child-Pugh stages disease. The companion guide works through both and their limits.
Read the trend, not the point
A move from 18 to 22 crosses a mortality band and changes urgency materially, while a move from 18 to 19 does not. Transplant teams read the score with its trend, the complications, and the patient, never as a standalone verdict.
Frequently asked questions
What is a MELD score?
MELD — the Model for End-Stage Liver Disease — is a score from 6 to 40 that estimates how severe chronic liver disease is and how urgently a patient needs a transplant. It is calculated from three blood tests: bilirubin, INR and creatinine. Higher means sicker, and in transplant systems the higher score generally means the higher place in the queue for a donor liver.
How is the MELD score calculated?
With this formula: MELD = 3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43, using labs in mg/dL. Three adjustments come first: any lab below 1.0 is set to 1.0, creatinine is capped at 4.0, and creatinine counts as 4.0 for anyone dialysed at least twice in the past week or given 24 hours of CVVH. The total is rounded to the nearest whole number and held between 6 and 40. This calculator applies every one of those rules and shows them in the working.
What is MELD-Na, and when does sodium count?
MELD-Na is the MELD score adjusted for serum sodium, because low sodium independently predicts a worse outcome in liver disease. Sodium only enters the calculation when the plain MELD score is above 11; at 11 or below, MELD-Na is simply the MELD score. The sodium used is clamped between 125 and 137 mmol/L — lower counts as 125, higher as 137 — and the formula is MELD-Na = MELD + 1.32 × (137 − Na) − 0.033 × MELD × (137 − Na), rounded and capped at 40 like the base score.
Why is creatinine capped at 4.0 and set to 4.0 for dialysis?
Creatinine reflects kidney function, but it also swings with muscle mass, diet and the dialysis machine itself. The cap at 4.0 stops one extreme kidney value from overwhelming the whole score. The dialysis rule exists because dialysis artificially lowers creatinine — without it, a very sick patient fresh from a dialysis session would look deceptively well on paper. Setting creatinine to 4.0 for anyone dialysed at least twice in the past week, or given 24 hours of CVVH, keeps their score honest.
What MELD score is needed for a liver transplant?
There is no single worldwide threshold. In the United States, livers are offered in score order within blood-type and geographic rules, and the score at which offers actually arrive varies a great deal by region and blood group — in many areas, scores in the high 20s or 30s are typical at transplant, while exception points and special categories complicate the picture further. Being evaluated and listed is a decision for a transplant centre, which weighs the score alongside many other factors. This page can only work out the number; it cannot say where that number puts you in any real queue.
Is this the exact score my transplant centre uses?
Not necessarily — and the difference matters. Since July 2023, liver allocation in the United States uses MELD 3.0, a newer formula that also counts albumin and female sex; your centre calculates that official score itself, from verified laboratory results. This page computes the classic MELD and MELD-Na exactly as published — still the standard reference in much of the world and in most research — which makes it right for understanding and checking scores, but never a substitute for the official figure on your file. If the two differ, the centre’s score is the one that counts.
What is MELD 3.0, and how is it different from MELD and MELD-Na?
MELD 3.0 is the refitted MELD formula used for liver allocation in the United States since 13 July 2023. It adds two inputs the older scores lack — serum albumin and female sex (+1.33 points for adult female candidates) — always counts sodium instead of only counting it when MELD is above 11, and caps creatinine at 3.0 instead of 4.0, with dialysis setting creatinine to 3.0. Every coefficient was refitted as well, and two interaction terms were added, so MELD 3.0 cannot be approximated by adding points to MELD-Na. Use the Advanced panel on this page to compute it from the same labs.
Why does MELD 3.0 add points for female sex?
Because the old formula scored women systematically lower than equally sick men. Creatinine, one of the three original labs, runs lower in people with less muscle mass, so a woman and a man with the same degree of liver and kidney failure could receive different creatinine values — and therefore different scores — for the same sickness. The +1.33 female term in MELD 3.0 corrects that measurement gap; it is an adjustment for a known bias in the inputs, not a preference added for its own sake. It applies to adult candidates; candidates registered before age 18 use a variant with no sex term.
What do the 90-day mortality percentages actually mean for one person?
They describe groups, not individuals. A band figure such as 19.6% for scores 20–29 means that, in the validation studies, about 19.6% of past patients in that band died within three months without a transplant — it does not mean any one patient with a score in that band has a 19.6% chance of dying. Individual prospects depend on far more than a handful of labs: infection, bleeding, frailty, other organs, how fast the labs are changing, and the exception points and listing rules that decide real allocation. Treat the percentages as a way to understand the scale of urgency, never as a personal prognosis, and never as a reason to change treatment.
Why is creatinine capped at 3.0 in MELD 3.0 but 4.0 in classic MELD?
Because the refit found that, in modern waitlist data, creatinine above 3.0 added almost no extra power to predict who would die within 90 days — the extra range was mostly noise from muscle mass, diet and assay differences rather than signal about sickness. Classic MELD, fitted on older data, kept the cap at 4.0. The dialysis rule follows the cap in each version: dialysis sets creatinine to 4.0 in classic MELD and to 3.0 in MELD 3.0. That is also why a dialysis patient’s two scores can differ by more than the albumin and sex terms alone would suggest.
Does MELD 3.0 apply to children?
No. MELD 3.0 is for candidates aged 12 and older, with a variant without the sex term for those registered before 18. Children under 12 are scored by PELD, a separate paediatric score.
Why do two calculators give different MELD scores?
Usually because of version or clamps: classic MELD, MELD-Na, and MELD 3.0 differ, and a creatinine above the cap or a dialysis flag changes the input. Check that the version and the clamps match before comparing.
Can a MELD score go down?
Yes. Improving labs, treating complications, or resolving kidney injury can lower the score, and the trend over weeks is more informative than any single value.