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MELD-Na Score (UNOS/OPTN 2016)

MELD-Na adds serum sodium (bounded 125–137 mmol/L) to MELD and was used for US liver allocation from 2016 to 2023. The sodium correction applies only when MELD >11; range 6–40, with referral for transplant evaluation usually at ≥15.

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

ResultMeaning
< 10~2% 3-month mortality
10–19~6%
20–29~20%
30–39~53%
≥ 40~71%

Formula

MELD(i) = round[0.957 ln(Cr) + 0.378 ln(bili) + 1.120 ln(INR) + 0.643, 1 dp] × 10 (labs <1 → 1; Cr ≤4.0; dialysis ≥2×/wk → Cr 4.0). If MELD(i) >11: MELD-Na = MELD(i) + 1.32 × (137 − Na) − 0.033 × MELD(i) × (137 − Na), Na bounded 125–137 mmol/L; rounded, max 40.

Clinical pearls

  • Hyponatremia raises the score most when the underlying MELD is low; the interaction term shrinks the sodium effect at high MELD.
  • Sodium below 125 is treated as 125, and above 137 as 137.
  • Since July 2023 US allocation uses MELD 3.0, which adds albumin and female sex.

Examples

meld-na bili 2.5 inr 1.0 cr 1.2 na 131MELD sodium: bilirubin 6, INR 1.5, creatinine 1.5, sodium 131meld na for cirrhotic with na 128 bili 12 inr 2.2 creat 1.8

FAQ

Why add sodium to MELD?

Hyponatremia independently predicts waitlist death, especially in patients with ascites and otherwise low MELD; adding sodium reclassifies these patients upward.

When is the sodium term not applied?

Under OPTN rules the sodium correction is applied only when the initial MELD(i) is greater than 11.

Evidence

  1. Kim WR et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359:1018–26.
  2. Kim WR et al. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology 2021;161:1887–95 (describes the OPTN MELD-Na rules).

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