MELD-Na Score
Model for End-Stage Liver Disease with sodium correction
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Why use it
Official score used for liver transplant allocation in the US (UNOS). More accurate than original MELD for predicting waitlist mortality. Guides timing of transplant listing and prioritization.
About
The MELD-Na score incorporates serum sodium into the original MELD model to improve 90-day mortality prediction in patients with end-stage liver disease. It is used by UNOS (since January 2016) for liver transplant allocation priority in the United States. MELD-Na better captures mortality risk in patients with hyponatremia, a common finding in advanced cirrhosis.
When to use
- Liver transplant candidate evaluation and listing priority
- Prognosis estimation in cirrhosis
- Decision on TIPS placement, surgical procedures in cirrhotic patients
- Monitoring disease progression in chronic liver disease
Formula
Pearls & pitfalls
- Serum Na is bounded between 125-137 mEq/L in the MELD-Na formula — values outside this range are capped.
- Lab values must be from the same day for accurate scoring.
- MELD-Na replaces MELD for UNOS allocation since January 2016.
- In 2022, UNOS transitioned to MELD 3.0, which incorporates sex and albumin — check if your institution uses MELD 3.0.
- INR can be falsely elevated by anticoagulants (warfarin) — this inflates the score.
- Minimum MELD score is 6, and values are rounded to the nearest integer for UNOS.
Next steps
MELD-Na ≥ 15: list for transplant evaluation. MELD-Na ≥ 20-25: increasing priority. Reassess every 7-90 days depending on score range. Combine with clinical assessment for transplant decision-making.
Evidence
Original MELD validated for TIPS mortality prediction, then adopted for transplant allocation. MELD-Na (Kim et al., Hepatology 2008) demonstrated improved c-statistic for 90-day waitlist mortality. UNOS adopted MELD-Na in 2016 after extensive validation.