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MELD Score (Model For End-Stage Liver Disease) (12 and older)

Calculates the MELD score to quantify end-stage liver disease for transplant planning.

Note: As of January 2016, the MELD formula has changed. It now includes serum sodium level. See OPTN's announcement.
mg/dL
mg/dL
mEq/L

Advice

  • Consider referral to hepatologist or liver transplant center for patients with MELD score ≥10.
  • MELD score should be periodically re-assessed, as it changes with changing lab values.
  • All cirrhosis patients should be periodically screened for hepatocellular carcinoma with serum alpha-fetoprotein (AFP) and by appropriate imaging to see if they can earn “standard MELD exceptions”.

Critical Actions

Standard MELD Exceptions

The following conditions are automatically assigned a MELD score of 22 (28 in case of hyperoxaluria), with a 10% increase in score every 3 months from diagnosis.

  • Hepatocellular carcinoma (HCC) with one lesion between 2 - 5 cm or two to three lesions <3 cm (Milan criteria), provided no vascular invasion or extrahepatic disease.
  • Hepatopulmonary syndrome with PaO2 <60 mmHg on room air.
  • Portopulmonary hypertension, with mean pulmonary artery pressure (mPAP) >25 mmHg at rest but maintained <35 mmHg with treatment.
  • Hepatic artery thrombosis 7-14 days post-liver transplantation.
  • Familial amyloid polyneuropathy, as diagnosed by identification of the transthyretin (TTR) gene mutation by DNA analysis or mass spectrometry in a biopsy sample and confirmation of amyloid deposition in an involved organ.
  • Primary hyperoxaluria with evidence of alanine glyoxylate aminotransferase deficiency (these patients requires combined liver-kidney transplantation).
  • Cystic fibrosis with FEV1 (forced expiratory volume in 1 second) <40%.
  • Hilar cholangiocarcinoma.