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MELD 3.0 (Kim 2021, OPTN 2023)

MELD 3.0 adds female sex and albumin to MELD-Na with updated coefficients and a creatinine cap of 3.0 mg/dL; it has been used for US liver allocation since July 2023. Range 6–40; higher scores mean higher 90-day waitlist mortality (score 20 ≈ 5% 90-day mortality).

  • Total bilirubin (mg/dL or µmol/L)
  • INR
  • Serum creatinine (mg/dL or µmol/L)
  • Serum sodium (mmol/L or mEq/L)
  • Serum albumin (g/dL or g/L)
  • Sex: Male; Female
  • Dialysis ≥2 times in the past week (or CVVHD ≥24 h) (yes/no)
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Interpretation

ResultMeaning
6–9Low short-term mortality
10–19Moderate
20–29High (score 20 ≈ 5% 90-day waitlist mortality)
≥ 30Very high; highest allocation priority

Formula

MELD 3.0 = 1.33 (if female) + 4.56 ln(bili) + 0.82 (137 − Na) − 0.24 (137 − Na) ln(bili) + 9.09 ln(INR) + 11.14 ln(Cr) + 1.85 (3.5 − Alb) − 1.83 (3.5 − Alb) ln(Cr) + 6; rounded. Bounds: labs <1 → 1; Cr max 3.0 (3.0 if dialysis ≥2×/wk or CVVHD); Na 125–137; albumin 1.5–3.5 g/dL; max 40.

Clinical pearls

  • Creatinine is capped at 3.0 mg/dL (not 4.0 as in MELD/MELD-Na), and dialysis sets creatinine to 3.0.
  • Women receive +1.33 to correct for creatinine underestimating renal dysfunction in smaller patients.
  • Albumin is bounded 1.5–3.5 g/dL, so albumin above 3.5 contributes nothing.

Examples

meld 3.0 female bili 6 inr 1.5 cr 1.5 na 131 alb 2.2MELD 3.0 for a man: bilirubin 2.5, INR 1.0, creatinine 1.2, sodium 131, albumin 3.8meld3 58M bili 12 inr 2.2 cr 2.8 na 128 albumin 20 g/L

FAQ

What changed from MELD-Na to MELD 3.0?

MELD 3.0 adds female sex and serum albumin, adds bilirubin–sodium and albumin–creatinine interactions, refits the coefficients and lowers the creatinine cap to 3.0 mg/dL.

Is MELD 3.0 used for transplant allocation?

Yes. The OPTN adopted MELD 3.0 for adult liver allocation in the United States in July 2023.

Evidence

  1. Kim WR et al. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology 2021;161:1887–95.

Hepatology & GI · Reviewed 2026-10-14 · Methodology