MELD (Model for End-Stage Liver Disease) and MELD-Na are survival models for people aged ≥12 years with advanced chronic liver disease, developed to estimate short-term (around 3-month) mortality and to inform liver transplant listing and priority.

MELD 3.0 adds serum albumin, an age/sex adjustment and interaction terms, and is the current HRSA/OPTN allocation calculation for candidates aged ≥12 years in the United States after the July 13, 2023 implementation update. MELD-Na remains useful for historical comparison and non-US contexts that still use sodium-adjusted MELD.

Original MELD was derived in adults with end-stage liver disease using serum bilirubin, creatinine and INR, and showed good discrimination for 3-month mortality across a range of aetiologies and disease severity.
Subsequent work using large transplant waiting-list cohorts demonstrated that hyponatraemia independently increases wait-list mortality and that adding serum sodium to MELD improves 90-day risk prediction.
Transplant networks including UNOS have adopted sodium-adjusted MELD for allocation in adults, truncating sodium to 125–137 mmol/L and constraining MELD and MELD-Na scores to the 6–40 range.

Approximate 3-month mortality in historical adult transplant-waiting-list cohorts is often grouped as:

MELD or MELD-Na band	Approximate 3-month mortality
6–9	~1–2%
10–19	~6%
20–29	~20%
30–39	~50%
40	~70%

These event rates come from historical cohorts of adults with advanced chronic liver disease on transplant waiting lists. Contemporary absolute risk varies by centre, comorbidities, aetiology and access to transplantation, but the risk gradient with increasing MELD and MELD-Na remains clinically useful.

MELD and MELD-Na perform best in decompensated cirrhosis and are less reliable in acute liver failure, acute-on-chronic liver failure with multi-organ failure, or conditions managed through MELD exception pathways (for example hepatocellular carcinoma, hepatopulmonary syndrome or portopulmonary hypertension). Children under 12 years use the related PELD score rather than MELD-Na.

MELD, MELD-Na and MELD 3.0 for Cirrhosis