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    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Model for End-Stage Liver Disease (Combined MELD)

    Offers multiple versions of MELD for liver transplant planning.

    IMPORTANT

    MDCalc has recently streamlined the MELD calculator collection.

    On this page, you'll find the original MELD Score (Pre-2016), MELD Na (UNOS/OPTN), and MELD 3.0. MELD Na is the current standard calculation for organ transplantation consideration in the United States.  MELD 3.0 better accounts for disparities in organ allotment based on sex. 

    When to Use
    Pearls/Pitfalls
    Why Use
    • Determines prognosis and prioritizes receipt of liver transplantation.

    MELD Na (UNOS/OPTN):

    • Primarily used to stratify patients ≥12 years old on liver transplant waiting lists.
    • Predicts mortality in the following scenarios: (a) after transjugular intrahepatic portosystemic shunt (TIPS), (b) cirrhotic patients undergoing non-transplantation surgical procedures, (c) acute alcoholic hepatitis, and (d) acute variceal hemorrhage.
    • Values should be no more than 48 hours old.
    • MELD can be used on any patient with end stage liver disease irrespective of cirrhosis etiology.

    MELD Na (UNOS/OPTN):

    • The MELD Score predicts three-month survival in patients (age 12+) with liver cirrhosis.
    • Scores range from 6 to 40, with higher scores correlating with increased severity of liver dysfunction and higher three-month mortality.
    • Several conditions are “standard MELD exceptions” and receive a different score (see Next Steps > Critical Actions):  hepatocellular carcinoma, hepatopulmonary syndrome, portopulmonary hypertension, familial amyloid polyneuropathy, primary hyperoxaluria, cystic fibrosis, hilar cholangiocarcinoma and hepatic artery thrombosis.
    • One of the exclusion criteria for the original data set was absence of acute reversible conditions such as spontaneous bacterial peritonitis or prerenal azotemia secondary to dehydration. Therefore, in principle, the score should only be applied after these reversible conditions have been treated, according to the authors (Kamath 2007).
    • MELD is the standard used by the Organ Procurement and Transplantation Network (OPTN) and determines who is the highest priority to receive liver transplants in the US.
    • It has been widely studied and validated.
    MELD Score (Original, Pre-2016)
    MELD Na (UNOS/OPTN)
    MELD 3.0

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    Next Steps
    Evidence
    Creator Insights
    Dr. Patrick S. Kamath

    About the Creator

    Patrick S. Kamath, MD, is a professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota. His research interests include acute-on-chronic liver failure, nonalcoholic fatty liver disease, polycystic liver disease, Budd-Chiari syndrome and hereditary hemorrhagic telangiectasia. Dr. Kamath is internationally renowned as a leading researcher in hepatology and has also won numerous awards as an educator.

    To view Dr. Patrick S. Kamath's publications, visit PubMed

    Are you Dr. Patrick S. Kamath? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. W. Ray Kim

    About the Creator

    W. Ray Kim, MD, is the Chief of the Division of Gastroenterology & Hepatology at Stanford University. He formerly studied in Seoul, South Korea, and completed fellowships in gastroenterology and hepatology at the Mayo Clinic.

    To view Dr. W. Ray Kim's publications, visit PubMed

    Are you Dr. W. Ray Kim? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Patrick S. Kamath
    Are you Dr. Patrick S. Kamath?
    Dr. W. Ray Kim
    Are you Dr. W. Ray Kim?
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