Hepatic Function

MELD-Na Score

Estimate 90-day liver transplant waitlist mortality and prioritise organ allocation.

When to use: MELD-Na is the current organ allocation score used by UNOS/OPTN and most transplant programs to prioritise patients on the liver transplant waiting list. Calculate it at the time of cirrhosis decompensation (ascites, variceal bleeding, encephalopathy, SBP) and at regular intervals thereafter. A MELD-Na ≥15 generally indicates the benefit of transplantation outweighs its risk, and listing should be considered.

Calculator

Serum Bilirubin(mg/dL)Minimum value used in formula: 1.0 mg/dL

INRMinimum value used in formula: 1.0

Serum Creatinine(mg/dL)Capped at 4.0 mg/dL; use 4.0 if on dialysis ≥2×/week

Serum Sodium(mEq/L)Capped between 125–137 mEq/L in the formula

Fill in all fields to see the result

Formula

MELD = 3.78×ln(Bilirubin) + 11.2×ln(INR) + 9.57×ln(Creatinine) + 6.43 MELD-Na = MELD + 1.32×(137−Na) − [0.24×(137−Na)×MELD] + 9.35 Caps: Creatinine max 4.0; Sodium 125–137 mEq/L; minimum values: Bili=1, INR=1, Cr=1 ≤9: Mild | 10–19: Moderate | 20–29: Severe | ≥30: Very severe

Key Points for NEET PG

MELD components: Bilirubin (liver function), INR (synthetic function), Creatinine (renal function; hepatorenal syndrome indicator).
MELD-Na adds sodium to MELD because hyponatraemia independently predicts mortality in cirrhosis even after adjusting for MELD.
MELD ≥15: transplant benefit outweighs surgical risk, the classic decision threshold.
Creatinine is capped at 4.0 mg/dL; patients on dialysis ≥2 times/week automatically get creatinine = 4.0.
MELD replaces Child-Pugh for transplant allocation because it is more objective (no subjective clinical parameters like ascites grading).

References

Kim WR et al. Hyponatremia and mortality among patients on the liver-transplant waiting list · N Engl J Med (2008)

Kamath PS et al. A model to predict survival in patients with end-stage liver disease · Hepatology (2001)

For educational purposes only. Not for clinical decision-making without professional oversight.

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