MELD 3.0 Calculator
MELD 3.0 is the score the US transplant system (OPTN) uses to rank adults waiting for a liver transplant. Higher scores mean a higher short-term risk of death without a transplant. It is for adults with chronic liver disease.
Source: Kim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology 2021;161(6):1887-1895.e4. (doi:10.1053/j.gastro.2021.08.050); Organ Procurement and Transplantation Network. OPTN Policies, Policy 9.1.D: MELD Score.
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For earlier-stage liver scarring, see the FIB-4 calculator.
The MELD 3.0 formula
MELD 3.0 = 1.33 (if female) + 4.56 × ln(bilirubin) + 0.82 × (137 − sodium) − 0.24 × (137 − sodium) × ln(bilirubin) + 9.09 × ln(INR) + 11.14 × ln(creatinine) + 1.85 × (3.5 − albumin) − 1.83 × (3.5 − albumin) × ln(creatinine) + 6
Before the calculation, each value is held inside fixed limits, following OPTN policy:
- Bilirubin, INR and creatinine below 1.0 are set to 1.0.
- Creatinine above 3.0 mg/dL is set to 3.0, and so is anyone who had dialysis twice or more, or 24 hours of continuous dialysis (CVVHD), in the past 7 days.
- Sodium is held between 125 and 137 mmol/L.
- Albumin is held between 1.5 and 3.5 g/dL.
The result is rounded to a whole number, with a minimum of 6 and a maximum of 40.
What changed from MELD-Na
MELD 3.0 adds albumin and sex to the older MELD-Na score and lowers the creatinine ceiling from 4.0 to 3.0 mg/dL. Women with the same lab results score 1.33 points higher, which the authors added to address a sex disparity in waiting-list outcomes. In the original study MELD 3.0 predicted 90-day survival slightly better than MELD-Na (C-statistic 0.869 vs 0.862) and moved a net 8.8% of people who died on the list into a higher tier, particularly women.
Worked examples from the original study
| Sex | Bilirubin | Sodium | INR | Creatinine | Albumin | MELD 3.0 | Predicted 90-day mortality |
|---|---|---|---|---|---|---|---|
| Male | 2.5 | 131 | 1.0 | 1.2 | 3.8 | 16 | 2.6% |
| Female | 2.5 | 131 | 1.0 | 1.2 | 3.8 | 17 | 3.1% |
| Male | 6.0 | 131 | 1.5 | 1.5 | 3.5 | 25 | 12.1% |
| Male | 6.0 | 131 | 1.5 | 1.5 | 2.2 | 26 | 14.5% |
| Female | 6.0 | 131 | 1.5 | 1.5 | 2.2 | 27 | 17.5% |
| Male | 12.0 | 128 | 2.2 | 1.8 | 2.0 | 34 | 47.1% |
| Male | 12.0 | 128 | 2.2 | 2.8 | 2.0 | 38 | 72.3% |
| Female | 12.0 | 128 | 2.2 | 2.8 | 2.0 | 39 | 79.1% |
Bilirubin and creatinine in mg/dL, sodium in mmol/L, albumin in g/dL. Source: Kim WR, et al., Gastroenterology 2021, Table 4.
When to think about transplant evaluation
The AASLD and American Society of Transplantation advise that evaluation for liver transplant be considered once a person with cirrhosis has a MELD of 15 or more, or a major complication such as fluid in the abdomen (ascites), confusion from liver disease (encephalopathy) or bleeding varices. That threshold was set using the original MELD score; no guideline has re-tested it for MELD 3.0.
This calculator is for adults. OPTN uses a different version for ages 12 to 17 and a separate score (PELD) for children under 12.
FAQs
What is a high MELD score?
Higher means a higher risk of death within 90 days without a transplant. In the original study, a MELD 3.0 of 20 matched about a 5% risk at 90 days, while scores in the high 30s matched over 70%.
What is the difference between MELD, MELD-Na and MELD 3.0?
Original MELD uses bilirubin, INR and creatinine. MELD-Na adds sodium. MELD 3.0 adds albumin and sex and lowers the creatinine cap to 3.0 mg/dL.
Why does sex change the score?
The MELD 3.0 authors found a sex disparity in waiting-list outcomes under the older score. Adding 1.33 points for women was part of their fix, and in their analysis it moved more women who died on the list into a higher tier.