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MELD-Na (OPTN 2016)

MELD with serum sodium — US liver allocation 2016–2023

Sources last checked: 2026-10-13

MELD-Na (OPTN 2016)

MELD with serum sodium — US liver allocation 2016–2023

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Not the Eurotransplant formula: Eurotransplant uses its own refitted reMELD-Na (different coefficients and caps). In the US, MELD 3.0 replaced MELD-Na in July 2023.

Source: Kim WR et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359(10):1018-1026. Implementation: OPTN Policy 9.1 (January 2016) as approved by the UNOS Board, November 2013.Open

What is the MELD-Na (OPTN 2016)?

MELD-Na adds serum sodium to the MELD score because hyponatraemia independently predicts death on the liver transplant waiting list. Kim et al. published the model in 2008, and OPTN/UNOS used it for US liver allocation from January 2016 until MELD 3.0 replaced it in July 2023.

When to use it

  • Prognosis in cirrhosis with hyponatraemia
  • Interpreting US literature and allocation data from 2016–2023
  • Research comparisons with other MELD versions

When not to use it

  • Eurotransplant allocation — Eurotransplant uses reMELD-Na with different coefficients
  • Patients whose sodium is acutely altered by infusions or diuretics without considering the clinical context

How it is calculated

MELD(i) as in the UNOS MELD (bounds 1.0 / creatinine 4.0, rounded, ×10). If MELD(i) > 11: MELD-Na = MELD(i) + 1.32 × (137 − Na) − 0.033 × MELD(i) × (137 − Na) Sodium bounded to 125–137 mmol/L; result rounded, maximum 40.

Clinical pearls and limitations

  • Not the Eurotransplant formula: Eurotransplant uses its own refitted reMELD-Na (different coefficients and caps). In the US, MELD 3.0 replaced MELD-Na in July 2023.
  • The sodium term is applied only when MELD(i) is above 11.
  • Sodium is bounded to 125–137 mmol/L before calculation.
  • Lowering sodium from 137 to 125 can add up to about 11 points.

Frequently asked questions

Is MELD-Na the same as the Eurotransplant MELD?

No. Eurotransplant uses reMELD-Na (since March 2025), which was refitted on Eurotransplant data and uses different coefficients and caps.

When is sodium added to MELD?

Under OPTN policy only if the initial MELD(i) is greater than 11.

What sodium limits does MELD-Na use?

Values below 125 mmol/L are set to 125 and values above 137 mmol/L to 137.

Evidence and guidelines

  1. Primary source: Kim WR et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359(10):1018-1026. Implementation: OPTN Policy 9.1 (January 2016) as approved by the UNOS Board, November 2013.
  2. UNOS Board, Liver & Intestinal Committee action, November 2013 — sodium bounds 125–137 and worked examples (MELD 20, Na 133 → 23; Na 127 → 27).

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