MELD Score

What is a MELD score?

The Model for End-Stage Liver Disease (MELD) is a scoring system that helps determine how urgently you need a liver transplant within the next 90 days. Transplant centers use the MELD score as one factor to prioritize who gets a liver transplant. This scoring system is only for people older than 12. For children younger than 12, the Pediatric End-Stage Liver Disease (PELD) score determines the priority for liver transplantation.

A MELD score gives you a number result — from six to 40. A higher score means you’re very sick with liver disease. People with higher MELD scores tend to be higher on the transplant waiting list because they have a higher risk of death (mortality).

Your provider calculates your MELD score based on the results of several blood tests:

• INR (international normalized ratio). This measures how well your blood clots. A longer clotting time usually means your liver isn’t functioning as well.
• Total bilirubin. This measures how well your liver metabolizes and releases (excretes) bile. Higher bilirubin levels mean poorer liver function.
• Creatinine. This measures kidney function. The reason why kidney function matters in liver disease is that when liver disease advances, your kidneys stop functioning.
• Serum sodium. This shows how much sodium is in your blood, which can tell how well your liver is working. Low levels mean poor liver function.
• Albumin levels. This is a protein your liver makes that helps retain water in your blood. Low levels can point to poor liver function.

While the MELD score is a factor in determining when you’ll get a liver transplant, it’s not the only factor. Your healthcare team considers your unique circumstances, including the type of liver disease you have and other health conditions you’re managing.

How is a MELD score calculated?

Healthcare providers calculate your MELD score using a blood sample. But the MELD calculation is complex and includes more than just your blood test results. Some of the other factors healthcare providers consider are:

• Your medical history, including the type of liver disease you have and how severe it is
• Your age and sex recorded at birth
• Other health conditions you have and if they could cause complications
• Social and lifestyle factors that can affect the success of the transplant

Sometimes, the MELD score doesn’t always reflect how urgently you need a transplant. In this case, your provider can request extra points be added to your score. Conditions that may qualify you for extra points include:

• Acute liver failure
• Liver cancer
• Hepatopulmonary syndrome (low oxygen in your blood due to liver disease)
• Portopulmonary hypertension (high blood pressure in your lungs caused by liver disease)
• Polycystic liver disease (rare genetic disease)
• Cholangitis (recurrent infection in the bile duct)

Ask your healthcare team about what goes into your MELD score and how it helps determine your need for a liver transplant. They can explain it to you and answer any questions you have.

How often is your MELD score updated?

Your healthcare provider will order blood tests on a regular basis to update your MELD score. The timing depends on the results of your last MELD score. These are general guidelines for how often your score will be recalculated. Only your provider can determine your frequency.

What does your MELD score tell you?

The MELD score tells your healthcare team:

1. Your risk of mortality in the next 90 days due to liver disease
2. How urgently you need a liver transplant

While it’s impossible to know for sure what your life expectancy is, a MELD score gives providers a general idea. Then, they use that score as a factor in determining your place on a liver transplant list.

A MELD score isn’t the only thing your provider uses to determine how long it may take for you to get a liver transplant. Other things like your blood type and the availability of donors in your region play a role, too.

When should I call my healthcare provider?

Contact your healthcare provider if you have any questions about your MELD score. Talk to your provider if you have concerns about the test results or what comes next in your treatment plan.