MELD-Na (Model for End-Stage Liver Disease with sodium)
Three-month mortality prediction in cirrhosis adjusted for serum sodium. Used by UNOS / OPTN since 2016 for liver allocation.
About this calculator
MELD-Na is a sodium-corrected version of MELD. Developed by Kim et al. (NEJM, 2008) in 14,730 UNOS patients. Since January 2016 the primary US liver allocation score. Formula: MELD-Na = MELD + 1.32 × (137 – Na) – [0.033 × MELD × (137 – Na)], applied only when Na is 125-137 mmol/L. Why the correction. Hyponatremia (Na <130) is an independent poor prognostic factor in cirrhosis. Patients with MELD 15 and Na 125 have 90-day mortality comparable to MELD 22 at normal sodium. Without correction these patients received lower transplant priority and died on the waiting list. Interpretation. Same as MELD, with priority for hyponatremic patients. MELD-Na >=15 – consider transplantation; >=21 – elevated priority; >=30 – status 1B (urgent) in UNOS. Clinical use. Liver allocation in US UNOS and Eurotransplant. Survival prognosis in decompensated cirrhosis. Monitoring response to hyponatremia treatment (fluid restriction, tolvaptan) – sodium normalization reduces MELD-Na and improves transplant-free survival in the first 6 months. MELD 3.0 (2023). Further UNOS modification adds sex (female +1.33) and albumin (non-linear function). Aim – remove gender inequity in transplant listing: women had less muscle mass and lower creatinine, falsely lowering their MELD at the same clinical severity. As of 2024 MELD 3.0 has replaced MELD-Na in the US.
Source
Formula version: kim-2008-optn-v1