MELD score (UNOS / OPTN)
Original MELD — 3-month mortality in end-stage liver disease
- OPTN / UNOS
Sources last checked: 2026-10-13
MELD score (UNOS / OPTN)
Original MELD — 3-month mortality in end-stage liver disease
This is the original UNOS formula, which Eurotransplant used as labMELD until 24 March 2025. Eurotransplant now allocates by reMELD-Na; the US moved to MELD-Na (2016) and MELD 3.0 (2023). INR is distorted by vitamin K antagonists and creatinine by low muscle mass.
What is the MELD score (UNOS / OPTN)?
The Model for End-Stage Liver Disease (MELD) estimates 3-month mortality from creatinine, bilirubin and INR. It was developed at the Mayo Clinic for TIPS candidates (Malinchoc 2000), generalised by Kamath et al. in 2001 and adopted by UNOS for US liver allocation in 2002. Eurotransplant used this formula as its labMELD until March 2025.
When to use it
- Estimating short-term prognosis in cirrhosis
- Referral and evaluation for liver transplantation
- Reproducing historical labMELD values (Eurotransplant before 25 March 2025)
When not to use it
- Current Eurotransplant allocation — use reMELD-Na
- Acute liver failure (separate urgency criteria apply)
- Patients on vitamin K antagonists, where the INR does not reflect liver function
How it is calculated
MELD(i) = 0.957 × ln(creatinine) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643 Creatinine and bilirubin in mg/dL. Values < 1.0 are set to 1.0; creatinine is capped at 4.0 and set to 4.0 after ≥ 2 dialyses (or 24 h CVVHD) in the past week. MELD = MELD(i) rounded to one decimal × 10 (range 6–40).
Clinical pearls and limitations
- This is the original UNOS formula, which Eurotransplant used as labMELD until 24 March 2025. Eurotransplant now allocates by reMELD-Na; the US moved to MELD-Na (2016) and MELD 3.0 (2023). INR is distorted by vitamin K antagonists and creatinine by low muscle mass.
- Lab values below 1.0 are set to 1.0, so the minimum score is 6; creatinine is capped at 4.0 mg/dL.
- Two or more dialyses (or 24 h CVVHD) in the past week set creatinine to 4.0 mg/dL.
- UNOS rounds MELD(i) to one decimal and multiplies by 10; the maximum is 40.
- Creatinine-based scores underestimate renal dysfunction in women and patients with low muscle mass.
Frequently asked questions
Does Eurotransplant still use the MELD score?
Eurotransplant used this UNOS MELD as labMELD until 24 March 2025. Since 25 March 2025 it uses the refitted reMELD-Na.
What is the MELD formula?
MELD(i) = 0.957 × ln(creatinine) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643, with creatinine and bilirubin in mg/dL, then × 10 and rounded.
How do I convert bilirubin and creatinine for MELD?
Bilirubin µmol/L ÷ 17.1 = mg/dL; creatinine µmol/L ÷ 88.4 = mg/dL.
Evidence and guidelines
- Primary source: Kamath PS et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33(2):464-470. Bounds and rounding: OPTN/UNOS Liver and Intestinal Organ Transplantation Committee, Board report November 2013 (MELD(i) specification).
- UNOS Board, Liver & Intestinal Committee action, November 2013 — MELD(i) worked example (creatinine 1.9, bilirubin 4.2, INR 1.2 → 20).
- Eurotransplant MELD calculator page — Eurotransplant replaced this labMELD with reMELD-Na on 25 March 2025.
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