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MELD Na (UNOS/OPTN)

MELD Na (UNOS/OPTN)

Estimates short-term survival in chronic liver disease using bilirubin, INR, and creatinine

MELD Na (UNOS/OPTN)

MELD Na (UNOS/OPTN)

Estimates short-term survival in chronic liver disease using bilirubin, INR, and creatinine

Serum Creatinine (mg/dL)
Measure of kidney function
Total Bilirubin (mg/dL)
Measure of liver function
INR (International Normalized Ratio)
Measure of blood clotting
Serum Sodium (mEq/L)
Norm: 136 - 145 mEq/L or mmol/L
Dialysis at least twice in the past week or CVVHD for ≥24 hours in the past week
MELD-Na Score
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Instructions

The MELD-Na score is a validated tool used to assess the severity of chronic liver disease and prioritize patients for liver transplantation. It is an update to the original MELD score, incorporating serum sodium alongside bilirubin, INR, and creatinine to better predict short-term mortality. To use this tool, input the patient’s laboratory values into the standardized formula. The resulting score provides a mortality estimate and helps guide transplant allocation decisions. This scoring system is required by UNOS/OPTN for liver transplant listing in many regions.

Overview
When to use
Why use
Evidences

Interpretation

MELD-Na Score

Mortality

< 9

1.9%

10 – 19

6.0%

20 – 29

19.6%

30 – 39

52.6%

≥ 40

71.3%

The OPTN/UNOS policy added serum sodium to MELD for adult liver allocation effective Jan 11, 2016 (Policy 9.1), after Board approval in June 2014; the change can increase scores, particularly when Na<126, and altered recertification schedules for some candidates.
https://unos.org/news/policy-and-system-changes-effective-january-11-2016-adding-serum-sodium-to-meld-calculation/

MELD-Na integrates hyponatremia into the original MELD to better predict waitlist mortality; early work demonstrated that including sodium improves short-term mortality discrimination compared with MELD alone, leading to its formal OPTN implementation in 2016 and reductions in waitlist mortality in U.S. data
https://www.xiahepublishing.com/2310-8819/JCTH-2024-00303

 U.S. allocation reports and reviews note decreased waiting time and improved prioritization for candidates with lower sodium after MELD-Na implementation, reflecting better alignment of score with mortality risk.
https://www.sciencedirect.com/science/article/pii/S1600613522098318

https://pmc.ncbi.nlm.nih.gov/articles/PMC8790309/

Overview
When to use
Why use
Evidences

The MELD-Na score is one of the most important tools in modern hepatology and transplant medicine. Initially designed to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS), the MELD score evolved into a central method for evaluating prognosis in advanced liver disease. The incorporation of serum sodium, which reflects complications such as ascites and hyponatremia, enhances the score’s accuracy in predicting mortality.

The MELD-Na is calculated using bilirubin, INR, creatinine, and serum sodium, with adjustments for extreme values. Scores typically range from 6 to 40, with higher values indicating worse prognosis. In liver transplantation, MELD-Na determines allocation priority, ensuring organs are directed to patients at greatest risk.

Beyond transplantation, it is also used for risk stratification, prognosis discussions, and clinical decision-making in patients with decompensated cirrhosis. Its widespread adoption reflects both its accuracy and practicality, as it relies on routine labs available in most clinical settings.

Overview
When to use
Why use
Evidences

Interpretation

MELD-Na Score

Mortality

< 9

1.9%

10 – 19

6.0%

20 – 29

19.6%

30 – 39

52.6%

≥ 40

71.3%

The OPTN/UNOS policy added serum sodium to MELD for adult liver allocation effective Jan 11, 2016 (Policy 9.1), after Board approval in June 2014; the change can increase scores, particularly when Na<126, and altered recertification schedules for some candidates.
https://unos.org/news/policy-and-system-changes-effective-january-11-2016-adding-serum-sodium-to-meld-calculation/

MELD-Na integrates hyponatremia into the original MELD to better predict waitlist mortality; early work demonstrated that including sodium improves short-term mortality discrimination compared with MELD alone, leading to its formal OPTN implementation in 2016 and reductions in waitlist mortality in U.S. data
https://www.xiahepublishing.com/2310-8819/JCTH-2024-00303

 U.S. allocation reports and reviews note decreased waiting time and improved prioritization for candidates with lower sodium after MELD-Na implementation, reflecting better alignment of score with mortality risk.
https://www.sciencedirect.com/science/article/pii/S1600613522098318

https://pmc.ncbi.nlm.nih.gov/articles/PMC8790309/

Frequently Asked Questions

Features and Services FAQs

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What values are needed for MELD-Na?+
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Why is sodium included?+
Can MELD-Na be used outside transplant evaluation?+
How often should MELD-Na be updated?+
Does dialysis affect the calculation?+

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Model for End-Stage Liver Disease (Combined MELD)