World Library  
Flag as Inappropriate
Email this Article

Model for End-Stage Liver Disease

Article Id: WHEBN0003533739
Reproduction Date:

Title: Model for End-Stage Liver Disease  
Author: World Heritage Encyclopedia
Language: English
Subject: United Kingdom Model for End-Stage Liver Disease, Meld, Pyloromyotomy, Hill repair, Artificial extracorporeal liver support
Collection: Digestive System Procedures, Hepatology, Medical Scoring System
Publisher: World Heritage Encyclopedia

Model for End-Stage Liver Disease

The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of Eurotransplant for prioritizing allocation of liver transplants instead of the older Child-Pugh score.[3][4]


  • Determination 1
  • Interpretation 2
  • History 3
  • See also 4
  • References 5
  • External links 6


MELD uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. It is calculated according to the following formula:[3]

MELD = 3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43

UNOS has made the following modifications to the score:[5]

  • If the patient has been dialyzed twice within the last 7 days, then the value for serum creatinine used should be 4.0
  • Any value less than one is given a value of 1 (i.e. if bilirubin is 0.8, a value of 1.0 is used) to prevent the occurrence of scores below 0 (the natural logarithm of 1 is 0, and any positive value below 1 would yield a negative result)

The etiology of liver disease was subsequently removed from the model because it posed difficulties such as how to categorize patients with multiple causes of liver disease. Modification of the MELD score by excluding etiology of liver disease did not significantly affect the model's accuracy in predicting three-month survival.

Patients with a diagnosis of liver cancer will be assigned a MELD score based on how advanced the cancer is.


In interpreting the MELD Score in hospitalized patients, the 3 month mortality is: [6]

  • 40 or more — 71.3% mortality
  • 30–39 — 52.6% mortality
  • 20–29 — 19.6% mortality
  • 10–19 — 6.0% mortality
  • <9 — 1.9% mortality


MELD was originally developed at the Mayo Clinic by Dr. Patrick Kamath, and at that point was called the "Mayo End-stage Liver Disease" score. It was derived in a series of patients undergoing TIPS procedures. The original version also included a variable based on the underlying etiology (cause) of the liver disease.[1] The score turned out to be predictive of prognosis in chronic liver disease in general, and–with some modifications–came to be applied as an objective tool in assigning need for a liver transplant. The etiology turned out to be relatively unimportant, and was also regarded as relatively subjective; it was therefore removed from the score.[3]

See also


  1. ^ a b Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (April 2000). "A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts". Hepatology 31 (4): 864–71.  
  2. ^ Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR (2001). "A model to predict survival in patients with end-stage liver disease". Hepatology 33 (2): 464–70.  
  3. ^ a b c d Kamath PS, Kim WR (March 2007). "The model for end-stage liver disease (MELD)". Hepatology 45 (3): 797–805.  
  4. ^ Jung GE, Encke J, Schmidt J, Rahmel A (February 2008). "Model for end-stage liver disease. New basis of allocation for liver transplantations". Chirurg (in German) 79 (2): 157–63.  
  5. ^ UNOS (2009-01-28). "MELD/PELD calculator documentation" (PDF). Retrieved 2010-02-21. 
  6. ^ Wiesner et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology (2003) vol. 124 (1) pp. 91-6. PMID 12512033

External links

  • Mobile friendly MELD score by MedWebApp
  • Model for End-Stage Liver Disease Calculator by MDCalc
  • Online calculator for MELD score/UNOS modification
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.