MELD 3.0 (Model for End-Stage Liver Disease)
What is the 90-day wait-list mortality risk in end-stage liver disease?
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About this tool
Updated MELD adding female sex and albumin, with bilirubin–sodium and albumin–creatinine interactions and a creatinine ceiling of 3.0 mg/dL; includes the published 90-day survival estimate.
Intended use
Adults with end-stage liver disease, particularly liver-transplant candidates.
Outcome
90-day wait-list mortality
Time horizon
90 days
Derivation population
Adults (≥ 18 years) registered on the US liver-transplant wait list, January 2016 – December 2018.
Do not use in
Derivation excluded previous liver transplant, multi-organ listings other than simultaneous liver–kidney, and exception points at registration.
Limitations
- Predicts wait-list mortality without transplantation, not outcomes after transplant.
- Creatinine reflects muscle mass and is affected by sarcopenia; dialysis status changes the score.
- Survival estimate uses the publication's simplified formula and derivation-cohort baseline.
Clinical problems
Evidence
Evidence level
Strong evidence
Derived and externally validated in multiple cohorts (including prospective studies) and incorporated into major clinical guidelines. Methodology
Guideline status
Adopted by OPTN for US liver allocation (implemented 2023).
Discrimination
C-statistic 0.869 vs 0.862 for MELDNa in the validation set (Kim 2021).
Geographic applicability
United States transplant population; external validations published in Europe and Asia.
Validation studies
OPTN wait-list registrants
C-statistic for 90-day mortality 0.8693 (MELD 3.0) vs 0.8622 (MELDNa); net 8.8% of decedents correctly reclassified to a higher MELD tier.
References
- Original publicationKim WR, Mannalithara A, Heimbach JK, et al. MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. Gastroenterology 2021;161:1887-1895. Find on PubMed (opens in a new tab)
Version history
| Version | Formula | Effective | Reviewer | Changes |
|---|---|---|---|---|
| v1.0.0 | Kim 2021 equation and bounds; 90-day survival per Supplementary Table 4 | 2026-10-03 | — | Initial implementation with reference test vectors. |
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