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MELD Score (original UNOS MELD)

The original MELD score (UNOS version) predicts 3-month mortality in cirrhosis from bilirubin, INR and creatinine; range 6–40. Scores ≥15 generally warrant transplant referral; MELD-Na and MELD 3.0 have since replaced it for US organ allocation.

  • Total bilirubin (mg/dL or µmol/L)
  • INR
  • Serum creatinine (mg/dL or µmol/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 = 10 × [0.957 × ln(Cr) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643], rounded. Values <1.0 set to 1.0; creatinine capped at 4.0 mg/dL and set to 4.0 if dialysed ≥2× in the past week (or CVVHD ≥24 h); maximum 40.

Clinical pearls

  • UNOS rounds the term in brackets to one decimal before multiplying by 10, so the score is always an integer.
  • Mortality bands are 3-month waitlist mortality in chronic liver disease (Wiesner 2003: 1.9% below 9, 71.3% at ≥40); other settings differ.
  • For US listing MELD-Na (2016) and then MELD 3.0 (2023) replaced the original MELD; use those for allocation questions.

Examples

meld bili 3.2 inr 1.8 cr 1.4MELD score for bilirubin 55 umol/L, INR 1.6, creatinine 120 umol/Lmeld bili 6 inr 2.1 creat 2.5 on dialysis

FAQ

What MELD score qualifies for a liver transplant referral?

Referral for transplant evaluation is generally recommended at MELD ≥15, or earlier for decompensation (ascites, variceal bleeding, encephalopathy, HCC).

What is the maximum MELD score?

MELD is capped at 40; the lowest possible score is 6.

Evidence

  1. Kamath PS et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–70.
  2. Malinchoc M et al. A model to predict poor survival in patients undergoing TIPS. Hepatology 2000;31:864–71.
  3. Wiesner R et al. MELD and allocation of donor livers. Gastroenterology 2003;124:91–6.

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