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MELD 3.0

MELD updated with sex and albumin (Kim 2021) — US liver allocation since 2023

Sources last checked: 2026-11-03

MELD 3.0

MELD updated with sex and albumin (Kim 2021) — US liver allocation since 2023

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A US allocation score: Eurotransplant (Germany, Austria and partners) allocates by reMELD-Na, and Turkey uses its own national rules, so MELD 3.0 values are not the number used for European listing. The dialysis rule follows the OPTN implementation; the paper itself specifies only the 3.0 mg/dL creatinine ceiling.

Source: Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SW, Wood NL, Gentry SE, Kwong AJ. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology 2021;161(6):1887-1895.e4.Open

What is the MELD 3.0?

MELD 3.0 updates the MELD-Na score with female sex and serum albumin, adds interaction terms (bilirubin × sodium, albumin × creatinine) and lowers the creatinine ceiling from 4.0 to 3.0 mg/dL. Kim and colleagues derived it from US waiting-list registrations 2016–2018 to predict 90-day survival; it replaced MELD-Na for US liver allocation in 2023.

When to use it

  • Estimating short-term mortality in end-stage liver disease, especially to compare with US literature
  • Understanding US listing priority
  • Women with cirrhosis, whose risk MELD-Na underestimates

When not to use it

  • Eurotransplant listing (Germany, Austria and partners) — reMELD-Na applies
  • Children under 12 (PELD) and situations with standard exceptions (e.g. hepatocellular carcinoma)
  • Acute liver failure

How it is calculated

MELD 3.0 = 1.33 (female) + 4.56 ln(Bili) + 0.82 (137 − Na) − 0.24 (137 − Na) ln(Bili) + 9.09 ln(INR) + 11.14 ln(Cr) + 1.85 (3.5 − Alb) − 1.83 (3.5 − Alb) ln(Cr) + 6 Bounds: Bili, INR, Cr ≥ 1.0; Cr ≤ 3.0; Na 125–137; Alb 1.5–3.5. Rounded.

Clinical pearls and limitations

  • A US allocation score: Eurotransplant (Germany, Austria and partners) allocates by reMELD-Na, and Turkey uses its own national rules, so MELD 3.0 values are not the number used for European listing. The dialysis rule follows the OPTN implementation; the paper itself specifies only the 3.0 mg/dL creatinine ceiling.
  • Women receive 1.33 points for identical laboratory values, correcting the sex disparity created by creatinine.
  • Albumin has little effect once creatinine is high, because of the albumin × creatinine interaction.
  • In the derivation cohort a MELD 3.0 of 20 corresponded to a predicted 90-day mortality of 5.4 %.
  • Albumin infusions raise the measured albumin and lower the score; interpret accordingly.

Frequently asked questions

What is the MELD 3.0 formula?

1.33 (female) + 4.56 ln(bilirubin) + 0.82 (137 − Na) − 0.24 (137 − Na) ln(bilirubin) + 9.09 ln(INR) + 11.14 ln(creatinine) + 1.85 (3.5 − albumin) − 1.83 (3.5 − albumin) ln(creatinine) + 6, with bounds on each input.

MELD 3.0 vs MELD-Na — what changed?

Female sex and albumin were added, two interaction terms introduced and the creatinine cap lowered to 3.0 mg/dL; discrimination improved slightly (C-index 0.869 vs 0.862).

Does Eurotransplant use MELD 3.0?

No. Eurotransplant uses its own refitted reMELD-Na; MELD 3.0 is the US (OPTN) score.

Evidence and guidelines

  1. Primary source: Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SW, Wood NL, Gentry SE, Kwong AJ. MELD 3.0: the Model for End-Stage Liver Disease updated for the modern era. Gastroenterology 2021;161(6):1887-1895.e4.

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