Table of ContentsView AllTable of ContentsWhat It’s Used ForHow It’s DeterminedLimitationsBefore the TestScore InterpretationFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What It’s Used For
How It’s Determined
Limitations
Before the Test
Score Interpretation
Frequently Asked Questions
A MELD score, short for Model for End-Stage Liver Disease, can provide important information about liver failure prognosis and inform decisions aboutliver transplant. It is based on key lab test results used to measure liver function.
While a good tool, the MELD score is a statistical measure and does not take into account several factors that might affect your individual prognosis. A MELD score interpretation should always be considered within the context of clinical findings and your specific medical history.
This article explains how a MELD score is calculated. It will help you understand what the MELD values mean, as well as what limitations and considerations should be kept in mind when interpreting your score.
Tharakorn / Stock Photo
Purpose of MELD Score
MELD score tests can be used for anyone over the age of 12 with end-stage liver disease, regardless of the cause of the disease.
A modified MELD score (the PELD score) is used for children under the age of 12. With children, age less than 12 months or the failure to grow are also considered.
There are several reasons for why your healthcare provider may recommend calculating your MELD score.
Liver Transplantation Prioritization
The MELD score is used to make decisions about liver transplants among people with end-stage liver disease. Far more livers are needed than there are donor organs, and it’s a tool to help make challenging assessments about risks and benefits in specific cases.
Short-Term Risk of Death
The MELD score is used to predict mortality (the risk of death) over the next 90 days of illness in cases including:
The MELD score may also help predict longer term survival for a wide range of liver diseases, including esophageal varices, spontaneous bacterial peritonitis, and hepatorenal syndrome.
A 2020 study suggested MELD scores might also inform prognosis after surgery to remove liver cancer, and be used to assess surgical risk in people with liver disease with or without cirrhosis.
History of the MELD Score
Calculating Your MELD Score
A MELD score is calculated using the results of key laboratory tests, as well as any recent dialysis data related to renal (kidney) failure.
Values used in the calculation include:
Blood tests need to be performed within 48 hours of the time the calculation is made to be accurate and to qualify for liver transplant consideration.
Since the formula used to determine the score is complex, a MELD calculator is often to do the number crunching. The Organ Procurement & Transplantation Network, part of the U.S. Department of Health & Human Services, has aMELD Calculatorthat anyone can use.
The MELD score is a statistical test. Apart from a MELD score, prognosis includes several factors not included in the calculation, such as:
A 2019 study found that sex, age, and family support for high-risk people were all factors not included in the MELD score. In the lower risk group, family support, the liver function test AST, and albumin (a measure of protein in the blood) were important to the prognosis in addition to MELD scores.
Liver Function Tests and MELDLiver function tests do not necessarily correlate with the severity of liver disease. For example, lab tests may be abnormal in some people with mild disease, but relatively normal in people with severe disease.There is also a lag time in blood tests that may not reflect current changes in liver disease, such as improvement.
Liver Function Tests and MELD
Liver function tests do not necessarily correlate with the severity of liver disease. For example, lab tests may be abnormal in some people with mild disease, but relatively normal in people with severe disease.There is also a lag time in blood tests that may not reflect current changes in liver disease, such as improvement.
What to Expect During Liver Function Tests
Your healthcare provider will talk to you about the reasons for calculating your MELD score, as well as any potential limitations that may pertain to you as an individual. If you will be having your blood drawn at a different location, your healthcare provider will likely wish for you to bring the results with you to your appointment.
When the MELD calculation is complete, healthcare providers can sometimes estimate the chance that liver disease is or is not related to alcohol use. It’s very important to openly talk to your healthcare provider, even if you are embarrassed about things in your past. It’s also important to bring a caregiver with whom you are comfortable in being honest.
The MELD score test can be done rapidly, and your healthcare provider may do the calculation before your visit or while in the exam room with you. Since the lab values must be 48 hours old or less, some healthcare providers recommend blood draws early in the week.
MELD Score Interpretation
Standard MELD Exceptions
A MELD score is modified in certain situations. An automatic MELD score of 22 is given with the following medical conditions:
With primary hyperoxaluria, for which a combination kidney and liver transplantation is needed, an automatic MELD score of 28 is assessed.
MELD Score References
The “normal MELD score” is based on the individual, but with a MELD score of greater than or equal to 10, you may be referred to a hepatologist, or liver specialist.
Keep in mind that MELD scores are meant to assess the risk of death within three months, which may support a decision to recommend a liver transplant in order to avoid this high risk.
Here, a 2017 study outlined the average MELD score and three-month mortality as follows:
What MELD Score Is Needed For a Liver Transplant?
Liver transplant candidates based on MELD scores are prioritized as follows (with higher priority given to children under the age of 18):
That said, there are priority situations in which transplantation may be considered regardless of score. These include:
Can a MELD Score Improve?A MELD score can improve with treatment for some conditions, such as hepatitis B-related cirrhosis.The MELD score also should be recalculated sooner than normal if there are signs that liver failure is getting worse.
Can a MELD Score Improve?
A MELD score can improve with treatment for some conditions, such as hepatitis B-related cirrhosis.The MELD score also should be recalculated sooner than normal if there are signs that liver failure is getting worse.
Other Considerations
Along with MELD scores, anyone with cirrhosis should discuss regular screening for liver cancer with their healthcare provider. A person diagnosed with liver cancer who does not otherwise qualify for a transplant may meet the criteria based on the standard exemptions.
A Word From Verywell
A MELD score is just one factor in decisions about your liver disease and overall health. You may be referred to a liver specialist on the basis of a MELD score, but you can make that decision with your healthcare provider. You also may want to consider a second opinion, and to seek out a support network as you learn more about your prognosis.
Frequently Asked QuestionsCirrhosis has several causes, including alcoholic liver disease,hepatitis,medication use,non-alcoholic fatty liver disease,primary biliary cholangitis,hemochromatosis,Wilson’s disease(copper overload),primary sclerosing cholangitis, and biliary atresia.Absolute contraindications for liver transplant include current substance use (including alcohol), severe heart or lung disease, most cancers, certain uncontrolled infections or life-threatening diseases, and birth defects associated with premature death.Learn MoreAll About Liver Transplants
Cirrhosis has several causes, including alcoholic liver disease,hepatitis,medication use,non-alcoholic fatty liver disease,primary biliary cholangitis,hemochromatosis,Wilson’s disease(copper overload),primary sclerosing cholangitis, and biliary atresia.
Absolute contraindications for liver transplant include current substance use (including alcohol), severe heart or lung disease, most cancers, certain uncontrolled infections or life-threatening diseases, and birth defects associated with premature death.Learn MoreAll About Liver Transplants
Absolute contraindications for liver transplant include current substance use (including alcohol), severe heart or lung disease, most cancers, certain uncontrolled infections or life-threatening diseases, and birth defects associated with premature death.
Learn MoreAll About Liver Transplants
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-yKim HJ, Lee HW.Important predictor of mortality in patients with end-stage liver disease.Clinical Molecular Hepatology.2013;19(2):105-15. doi:10.3350/cmh.2013.19.2.105Allegretti AS, Frenk NE, Li DK, et al.Evaluation of model performance to predict survival after transjugular intrahepatic portosystemic shunt placement.PLoS One.2019;14(5):e0217442. doi:10.1371/journal.pone.0217442Zaydfudim VM, Turrentine FE, Smolkin ME, et al.The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection.American Journal of Surgery. 2020. doi:10.1016/j.amjsurg.2020.01.022Kim Y, Kim K, Jang I.Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: A retrospective cohort study.Medicine (Baltimore).2019. 98(45):e17862. doi:10.1097/MD.0000000000017862Johnson SA, Vazquez SR, Fleming R, Lanspa MJ.Correction factor to improve agreement between point-of-care and laboratory International Normalized Ratio values.Am J Health Syst Pharm. 2017;74(1):e24-e31. doi:10.2146/ajhp150813Ahmed Z, Ahmed U, Walayat S, et al.Liver function tests in identifying patients with liver disease.Clin Exp Gastroenterol. 2018;11:301–307. doi:10.2147/CEG.S160537Aiello FI, Bajo M, Marti F, Gadano A, Musso CG.Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns.AME Medical Journal. 2017; 2:168. doi:10.21037/amj.2017.10.10University of Wisconsin School of Medicine and Public Health.MELD scores and PELD scores.Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW,et al.On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis.Am J Gastroenterol. 2018 Nov;113(11):1629-1638. doi:10.1038/s41395-018-0247-9.Additional ReadingKartoun Y, Corey KE, Simon TG, et al.The MELD-Plus: A generalizable prediction risk score in cirrhosis.PLoS One.2017. 12(10):e0186301. doi:10.1371/journal.pone.0186301Koola JD, Ho S, Chen G, et al.Development of a national Department of Veterans Affairs mortality risk prediction model among patients with cirrhosis.BMJ Open Gastroenterology. 2019;6(1):e000342. doi:10.1136/bmjgast-2019-000342Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-ySingal AK, Bataller R, Ahn J, Kamath PS, Shah VH.ACG clinical guideline: alcoholic liver disease.American Journal of Gastroenterology. 2018;113(2):175-194. doi:10.1038/ajg.2017.469U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network.MELD calculator.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-yKim HJ, Lee HW.Important predictor of mortality in patients with end-stage liver disease.Clinical Molecular Hepatology.2013;19(2):105-15. doi:10.3350/cmh.2013.19.2.105Allegretti AS, Frenk NE, Li DK, et al.Evaluation of model performance to predict survival after transjugular intrahepatic portosystemic shunt placement.PLoS One.2019;14(5):e0217442. doi:10.1371/journal.pone.0217442Zaydfudim VM, Turrentine FE, Smolkin ME, et al.The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection.American Journal of Surgery. 2020. doi:10.1016/j.amjsurg.2020.01.022Kim Y, Kim K, Jang I.Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: A retrospective cohort study.Medicine (Baltimore).2019. 98(45):e17862. doi:10.1097/MD.0000000000017862Johnson SA, Vazquez SR, Fleming R, Lanspa MJ.Correction factor to improve agreement between point-of-care and laboratory International Normalized Ratio values.Am J Health Syst Pharm. 2017;74(1):e24-e31. doi:10.2146/ajhp150813Ahmed Z, Ahmed U, Walayat S, et al.Liver function tests in identifying patients with liver disease.Clin Exp Gastroenterol. 2018;11:301–307. doi:10.2147/CEG.S160537Aiello FI, Bajo M, Marti F, Gadano A, Musso CG.Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns.AME Medical Journal. 2017; 2:168. doi:10.21037/amj.2017.10.10University of Wisconsin School of Medicine and Public Health.MELD scores and PELD scores.Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW,et al.On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis.Am J Gastroenterol. 2018 Nov;113(11):1629-1638. doi:10.1038/s41395-018-0247-9.Additional ReadingKartoun Y, Corey KE, Simon TG, et al.The MELD-Plus: A generalizable prediction risk score in cirrhosis.PLoS One.2017. 12(10):e0186301. doi:10.1371/journal.pone.0186301Koola JD, Ho S, Chen G, et al.Development of a national Department of Veterans Affairs mortality risk prediction model among patients with cirrhosis.BMJ Open Gastroenterology. 2019;6(1):e000342. doi:10.1136/bmjgast-2019-000342Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-ySingal AK, Bataller R, Ahn J, Kamath PS, Shah VH.ACG clinical guideline: alcoholic liver disease.American Journal of Gastroenterology. 2018;113(2):175-194. doi:10.1038/ajg.2017.469U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network.MELD calculator.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-yKim HJ, Lee HW.Important predictor of mortality in patients with end-stage liver disease.Clinical Molecular Hepatology.2013;19(2):105-15. doi:10.3350/cmh.2013.19.2.105Allegretti AS, Frenk NE, Li DK, et al.Evaluation of model performance to predict survival after transjugular intrahepatic portosystemic shunt placement.PLoS One.2019;14(5):e0217442. doi:10.1371/journal.pone.0217442Zaydfudim VM, Turrentine FE, Smolkin ME, et al.The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection.American Journal of Surgery. 2020. doi:10.1016/j.amjsurg.2020.01.022Kim Y, Kim K, Jang I.Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: A retrospective cohort study.Medicine (Baltimore).2019. 98(45):e17862. doi:10.1097/MD.0000000000017862Johnson SA, Vazquez SR, Fleming R, Lanspa MJ.Correction factor to improve agreement between point-of-care and laboratory International Normalized Ratio values.Am J Health Syst Pharm. 2017;74(1):e24-e31. doi:10.2146/ajhp150813Ahmed Z, Ahmed U, Walayat S, et al.Liver function tests in identifying patients with liver disease.Clin Exp Gastroenterol. 2018;11:301–307. doi:10.2147/CEG.S160537Aiello FI, Bajo M, Marti F, Gadano A, Musso CG.Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns.AME Medical Journal. 2017; 2:168. doi:10.21037/amj.2017.10.10University of Wisconsin School of Medicine and Public Health.MELD scores and PELD scores.Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW,et al.On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis.Am J Gastroenterol. 2018 Nov;113(11):1629-1638. doi:10.1038/s41395-018-0247-9.
Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-y
Kim HJ, Lee HW.Important predictor of mortality in patients with end-stage liver disease.Clinical Molecular Hepatology.2013;19(2):105-15. doi:10.3350/cmh.2013.19.2.105
Allegretti AS, Frenk NE, Li DK, et al.Evaluation of model performance to predict survival after transjugular intrahepatic portosystemic shunt placement.PLoS One.2019;14(5):e0217442. doi:10.1371/journal.pone.0217442
Zaydfudim VM, Turrentine FE, Smolkin ME, et al.The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection.American Journal of Surgery. 2020. doi:10.1016/j.amjsurg.2020.01.022
Kim Y, Kim K, Jang I.Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: A retrospective cohort study.Medicine (Baltimore).2019. 98(45):e17862. doi:10.1097/MD.0000000000017862
Johnson SA, Vazquez SR, Fleming R, Lanspa MJ.Correction factor to improve agreement between point-of-care and laboratory International Normalized Ratio values.Am J Health Syst Pharm. 2017;74(1):e24-e31. doi:10.2146/ajhp150813
Ahmed Z, Ahmed U, Walayat S, et al.Liver function tests in identifying patients with liver disease.Clin Exp Gastroenterol. 2018;11:301–307. doi:10.2147/CEG.S160537
Aiello FI, Bajo M, Marti F, Gadano A, Musso CG.Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns.AME Medical Journal. 2017; 2:168. doi:10.21037/amj.2017.10.10
University of Wisconsin School of Medicine and Public Health.MELD scores and PELD scores.
Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW,et al.On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis.Am J Gastroenterol. 2018 Nov;113(11):1629-1638. doi:10.1038/s41395-018-0247-9.
Kartoun Y, Corey KE, Simon TG, et al.The MELD-Plus: A generalizable prediction risk score in cirrhosis.PLoS One.2017. 12(10):e0186301. doi:10.1371/journal.pone.0186301Koola JD, Ho S, Chen G, et al.Development of a national Department of Veterans Affairs mortality risk prediction model among patients with cirrhosis.BMJ Open Gastroenterology. 2019;6(1):e000342. doi:10.1136/bmjgast-2019-000342Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-ySingal AK, Bataller R, Ahn J, Kamath PS, Shah VH.ACG clinical guideline: alcoholic liver disease.American Journal of Gastroenterology. 2018;113(2):175-194. doi:10.1038/ajg.2017.469U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network.MELD calculator.
Kartoun Y, Corey KE, Simon TG, et al.The MELD-Plus: A generalizable prediction risk score in cirrhosis.PLoS One.2017. 12(10):e0186301. doi:10.1371/journal.pone.0186301
Koola JD, Ho S, Chen G, et al.Development of a national Department of Veterans Affairs mortality risk prediction model among patients with cirrhosis.BMJ Open Gastroenterology. 2019;6(1):e000342. doi:10.1136/bmjgast-2019-000342
Samuel D, Coilly A.Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.BMC Medicine.2018. 16(1):113. doi:10.1186/s12916-018-1110-y
Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH.ACG clinical guideline: alcoholic liver disease.American Journal of Gastroenterology. 2018;113(2):175-194. doi:10.1038/ajg.2017.469
U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network.MELD calculator.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
