MELD score

Scoring system for assessing the severity of chronic liver disease. 

It was initially developed to predict death within three months of surgery in patients who had undergone TIPS and was subsequently found to be useful in determining prognosis and prioritizing for receipt of a liver transplant. 

This score is now used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants instead of the older Child-Pugh score.

The MELD range from 6 to 40 points. This range predict 3 months survival without liver transplantation in patients with liver cirrhosis.

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

• 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

The United Kingdom MELD (UKELD) score is derived from the patient's serum sodium, creatinine and bilirubin, and INR.
Minimal listing criteria require that the patient should have a projected 1-year liver disease mortality without transplantation of more than 9%. This is predicted by a UKELD score of 49 or greater. 
A UKELD score of 60 is predictive of a 50% 1-year survival.

at MELD score of 15 or greater, survival is enhanced 1 year after liver transplantation versus remaining in the waiting list. Therfore, most transplant centres designate a MELS score of 15 as the minimal listing score for liver transplantion.