MELD and Child-Pugh scores measure how serious your liver disease is.
MELD Score
If you’re an adult with liver disease that may call for a transplant, your MELD score helps to tell how quickly you might need it.
A MELD score is a number that ranges from 6 to 40, based on lab tests. It ranks your degree of sickness, which shows how much you need a liver transplant . The higher the number, the more urgent your case is.
What does MELD stand for?
MELD stands for "model for end-stage liver disease." Doctors use a similar system, called PELD (pediatric end-stage liver disease), for children younger than 12. If you have advanced liver disease, a MELD score helps your doctor determine your chances of surviving over the next three months.
Reasons for a liver transplant
Reasons why you might need a liver transplant include diseases that can lead to cirrhosis (scarring of the liver), which then causes liver failure, such as:
- Infections, especially hepatitis B and C
- Alcoholic liver disease, or liver disease caused by alcohol
- Metabolic dysfunction-associated steatotic liver disease (MASLD), a condition where fat builds up in your liver (formerly called nonalcoholic fatty liver disease, or NAFLD)
- Metabolic dysfunction-associated steatohepatitis (MASH), the most severe form of MASLD (formerly called nonalcoholic steatohepatitis, or NASH)
- Hemochromatosis, a genetic disorder that causes too much iron to build up in your body
- Wilson's disease, a genetic disorder that causes too much copper to build up in your body
- Primary biliary cholangitis (formerly called primary biliary cirrhosis), an autoimmune disease that damages your bile ducts, which carry bile inside the liver
- Primary sclerosing cholangitis, a rare disease that causes your bile ducts to scar
- Biliary atresia, a blockage in a baby’s bile ducts
- Certain types of liver cancer
MASH is now the leading cause of cirrhosis and liver transplants in the United States. Up to 25% of people with MASH have cirrhosis.
Alcohol use doesn’t cause MASLD and MASH. You’re more likely to develop these conditions if you:
- Have overweight or obesity
- Have high cholesterol
- Have type 2 diabetes
- Don’t exercise or eat healthy
If your doctor says you need a liver transplant, you’ll be added to a waiting list managed by a national organization called the United Network for Organ Sharing. Your MELD score is one of several things that decide your place on the list.
How to Calculate a MELD Score
Your MELD score is based on results from several lab tests, including your:
- Creatinine level, which is related to how well your kidneys are working
- Bilirubin level, which shows how well your liver clears a substance called bile
- INR (international normalized ratio), which reflects how well your liver makes factors needed to help clot the blood.
- Serum sodium level, which shows the concentration of sodium in your blood
- Albumin level, which measures a protein that your liver makes. The albumin measurement was added to the MELD score formula in 2023.
The MELD score also takes your age and assigned sex at birth into account. People who are assigned female at birth are less likely to receive a liver transplant within three years of being on the list. They’re also more likely to die while they wait for a transplant.
One reason for this is that these patients often have something called creatine overestimating kidney function. This simply means their kidney scores appear better than they really are. Changes made to the MELD score formula in 2023 added a sex category to address this problem.
Since the formula used to calculate MELD is complex, there are online tools to help you figure out your score.
Your MELD score can change. For example, if you get sicker, your score will go up.
You’ll get your MELD score recalculated from time to time. Your doctor will decide when this needs to be done. Your score may be recalculated as often as once every week. Or, you may be retested as infrequently as once every year. Your medical condition, treatment, and previous MELD score all affect how often that’s done.
Typically, if your MELD score is:
- Under 10: It will be recalculated once a year.
- 11-18: It will be recalculated every 3 months.
- 19-24: It will be recalculated once a month.
- 25 or higher: It will be recalculated every week.
MELD score meaning
Your MELD score will tell your doctor how severe your liver disease is. It ranges from 6 to 40. People with higher MELD scores have higher priority on the transplant waiting list. In the U.S., the average MELD score is about 30 at the time of transplant.
Although there’s no way to predict exactly how long someone with liver disease will live, the MELD score can give doctors an idea. The following chart estimates your risk of dying after three months based on your MELD score:
MELD Score | 3-Month Risk of Mortality |
Less than 9 | 1.9% |
10–19 | 6.0% |
20–29 | 19.6% |
30–39 | 52.6% |
Greater than 40 | 71.3% |
MELD Isn’t Everything
A MELD score can’t predict your wait time on the transplant list. Other things affect when you could be offered a liver, including
- The supply of, and demand for, livers in your region
- How close you are, geographically, to the donated liver
- Blood type
- Body size
- Donor’s age
If a transplant center believes that your MELD score doesn’t accurately represent how urgently you need a liver transplant, it can try to add “exception points” to your score. To do this, it submits paperwork to a regional review board. Conditions that call for exception points include:
- Cholangiocarcinoma
- Cystic fibrosis
- Familial amyloid polyneuropathy (FAP)
- Hepatic artery thrombosis (HAT)
- Hepatocellular carcinoma (HCC)
- Hepatopulmonary syndrome (HPS)
- Metabolic disease
- Portopulmonary hypertension
- Primary hyperoxaluria
The transplant center will update information about your exception points every three months.
In a crisis, you may get a special priority status called Status 1A. This happens if your doctor believes that you may only have hours or days before you need a transplant to live.
Child-Pugh Score
The Child-Pugh score, also called the Child-Turcotte-Pugh score, rates how severe your long-term liver disease is.
It began in 1964 with two surgeons named Child and Turcotte, who designed it to predict the risk of death in people having a certain type of liver surgery. In 1973, a team led by a doctor named Pugh proposed changes.
The score helps suggest how strong your liver disease treatment should be. For example, depending on how your disease is classified, you may get medications or you may have surgery. It may also give doctors an idea of how patients will do after some other major operations.
Child-Pugh Scoring System
The Child-Pugh score uses five measures of liver disease:
- Total bilirubin: A yellowish compound found in bile and blood when hemoglobin breaks down
- Albumin: The main protein in blood plasma, which your liver makes
- Prothrombin time or INR: How long it takes your blood to clot
- Ascites: Fluid in your abdominal cavity
- Encephalopathy: Whether your liver disease is affecting your brain
Each measure gets one, two, or three points, with three being the most serious.
For example, if you have no ascites, you get one point in that category. If you have mild ascites, you get two points. If you have moderate or severe ascites, you get three points.
As with the MELD, there are online calculators available to compute your Child-Pugh score.
Child-Pugh Score Results
Once the scores are figured, they’re added up, and your liver disease is put in one of three classes: A, B, or C.
Child-Pugh Score Class A
5-6 points
- Your disease is mild.
- Surgery should be safe for you.
- The one-year survival rate for class A patients is 100%.
Child-Pugh Score Class B
7-9 points
- Your disease is moderate.
- You may have surgery.
- The one-year survival rate for class B patients is 80%.
Child-Pugh Score Class C
10-15 points
- Your disease is severe.
- You probably shouldn’t have surgery except for a liver transplant.
- The one-year survival rate for class C patients is 45%.
Some people question whether the Child-Pugh score is valid because some of the scoring is subjective. One doctor may rate ascites or encephalopathy differently than another, for example. But doctors say it’s a good tool for measuring how well the liver works and how severe liver disease is. It can also help chart a treatment plan.
In the past, the Child-Pugh score was used to determine a child’s place on the transplant waiting list. Now, PELD is the go-to tool. PELD ranks the priority of liver transplant candidates who are younger than age 12.
Child-Pugh Score and MELD Score Takeaways
The MELD and Child-Pugh scores are two tools that determine the health of your liver based on different medical markers.
- The MELD assigns you a score that ranges from 6 to 40. It gives doctors an idea of where you should be on the liver transplant waiting list if you’re 12 or older.
- A similar test, the PELD, is used for children under the age of 12.
- Doctors use the Child-Pugh score to measure how severe long-term liver disease is. It assigns a class (A, B, or C) to help you understand your outlook and come up with a treatment plan.
Child-Pugh Score and MELD Score FAQs
How do I calculate my MELD and Child-Pugh scores?
Your doctor will use a very specific formula to figure out your scores. There are several online calculators for MELD and Child-Pugh scores if you’re interested in seeing how the scores are computed.
Can my MELD score go down?
Yes, your MELD score can go up and down. It changes as your condition improves or worsens. Some research has suggested that a diet lower in sugar can improve your MELD score over time.
What happens if my MELD score is high?
If your MELD score is high, that means your liver function is poor. The higher your score, the more likely you are to receive a liver transplant if you are a candidate when an organ becomes available.
Does my Child-Pugh score affect my transplant waiting list spot?
A Child-Pugh score does not affect your spot on the transplant waiting list. Instead, it’s used to help doctors assess how severe your disease is and what treatments you should have. Doctors use another tool, the MELD score, to help doctors rank adults with liver failure on the liver transplant waiting list.
