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    Patent Pending

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

    Stratifies severity of end-stage liver disease, for transplant planning.
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    BEFORE USE

    Note: As of January 2016, calculation of the MELD has changed. It now includes serum sodium level. See OPTN's announcement.

    When to Use
    Pearls/Pitfalls
    Why Use
    mg/dL
    mg/dL
    mEq/L
    About the Creator
    Dr. Patrick S. Kamath
    Content Contributors
    • Pranav Patel, MD

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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.
    Content Contributors
    • Pranav Patel, MD