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What Are MELD and Child-Pugh Scores?

Reviewed by Minesh Khatri, MD on August 24, 2020

MELD and Child-Pugh scores measure the seriousness of your liver disease.

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.

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.

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.

Reasons why you might need a liver transplant include having conditions that cause liver failure, such as:

  • Cirrhosis
  • Hepatitis
  • Alcoholic liver disease
  • Hemochromatosis
  • Wilson's disease
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Biliary atresia

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 tells your place on the list.

Making 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 for blood clots
  • Serum sodium level, which shows the concentration of sodium in your blood

You’ll get your MELD score recalculated from time to time. Your medical condition, treatment, and previous MELD score all affect how often that’s done.

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.

To learn about your MELD score, you can talk with your doctor or enter your most recent lab results into a calculator on the Organ Procurement and Transplantation Network’s website.

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:

The transplant center will update information about your exception points every 3 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 the severity of long-term liver disease.

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.

How the Score Is Calculated

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 brain is affected by your liver disease

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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.

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.

Class A: Five to six points

  • Your disease is considered mild.
  • Surgery should be safe for you.

Class B: Seven to nine points

  • Your disease is considered moderate.
  • You may have surgery.

Class C: 10-15 points

  • Your disease is considered severe.
  • You probably shouldn’t have surgery except for a liver transplant.

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.

WebMD Medical Reference

Sources

SOURCES:

United Network for Organ Sharing: “Questions and Answers for Transplant Candidates About Liver Allocation.”

Mayo Clinic Staff: “Liver Transplant.”

Mayo Clinic: “Model for End-Stage Liver Disease (MELD).”

Columbia University Medical Center: “Liver Transplant Waiting List.”

Organ Procurement and Transplantation Network: "Policy 9: Allocation of livers and liver-intestines.”

California Pacific Medical Center, Sutter Health Network: “MELD and the Waiting List for Liver Transplant.”

Duquesne University Mylan School of Pharmacy: "What is the Child-Pugh scoring system and how does it relate to drug dosage?"

National Health Service: "What is the Child-Pugh Score?"

National Center for Biotechnology Information: "Bilirubin," "Albumin."

American Association for Clinical Chemistry, Lab Tests Online: "Albumin," "PT/INR."

American College of Gastroenterology: "Ascites: A Common Problem in People with Cirrhosis."

American Liver Foundation: "Hepatic Encephalopathy."

Digestive Diseases and Sciences: “The Child-Turcotte Classification: From Gestalt to Sophisticated Statistics and Back.”

Medicine: “Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis.”

StatPearls: “Use of the Child Pugh Score in Liver Disease.”

University of Wisconsin Health: “MELD and PELD Scores.”

United Network for Organ Sharing: “Questions and Answers for Transplant Patients about MELD and PELD.”

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