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Hepatology · UK

MELD, MELD‑Na and UKELD, explained properly.

The scores that grade chronic liver disease and decide transplant priority - MELD, MELD‑Na, MELD 3.0 and UKELD - read by a consultant hepatologist alongside your bloods, imaging and clinical picture.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private MELD and UKELD assessment costs in the UK.

Indicative ranges across UK private providers. Formal transplant listing itself is NHS at a tertiary centre - private work sits around the assessment and interpretation.

In short

£250–£450, plan the same day.

Service Indicative range
Hepatology consultation (MELD/UKELD review) £250–£450
Repeat bloods for scoring (LFT, INR, U&E) £120–£240
MRE liver stiffness £850–£1,400
CT liver volumetry £600–£900
Transplant assessment (multi‑day, tertiary) NHS / tertiary
Second‑opinion hepatology report £350–£600

Prices vary by hospital, by which hepatologist reads your bloods, by whether imaging is added on the day, and by whether a formal second opinion report is needed.

The problem

A number is not a plan.

MELD and UKELD are quietly powerful - and quietly misused. Online calculators give a number; they do not tell you whether you should be listed, re‑scored, or referred somewhere else.

  • Got a MELD number and no context?

    A MELD of 15 in stable cirrhosis is very different from a MELD of 15 that has climbed from 10 in a month. Trend matters.

  • Told UKELD is under 49?

    That is not the end of the conversation - variant syndromes list many patients at UKELD <49.

  • Want it read properly?

    A consultant hepatologist reads MELD, MELD‑Na, MELD 3.0 and UKELD together, with your imaging and endoscopy, not just the LFTs.

When it helps

When MELD and UKELD are the right tool.

The situations we see most, plus the one red flag that means an emergency rather than an appointment.

  • Cirrhosis of any cause

    Alcohol‑related, viral, MASH/NASH, autoimmune, PBC, PSC or genetic - MELD and UKELD grade severity across all of them.

  • Consideration for transplant listing

    The UK uses UKELD ≥49 as the historical listing threshold, with MELD‑Na complementary - an MDT decision at a transplant centre.

  • Pre‑op risk in a cirrhotic patient

    Non‑transplant surgery in cirrhotics is stratified by MELD - the higher the score, the higher the peri‑operative mortality.

  • Before a TIPS procedure

    MELD is used to estimate the risk of a transjugular intrahepatic portosystemic shunt (TIPS) in decompensated portal hypertension.

  • Prognosis and follow‑up cadence

    A rising MELD or UKELD changes how often you are seen, imaged and re‑scored. Falling scores after treatment matter too.

  • Variant‑syndrome listing route

    HCC within Milan criteria, hepatopulmonary syndrome, portopulmonary hypertension, refractory ascites, recurrent variceal bleeding or PSC cholangitis may allow listing at UKELD <49.

  • Paediatric liver disease (PELD)

    Children under 12 use PELD - albumin, INR, bilirubin, growth failure and age <1 - a different score than the adult one.

  • Red flag: acute decompensation

    New jaundice, confusion, GI bleeding or a rapidly rising MELD is not a clinic booking - same‑day hospital assessment, please.

Score options

MELD is not the only score in the room.

What each score actually measures - and which the UK uses for listing.

  • Original MELD

    3.78 × ln(bilirubin) + 11.2 × ln(INR) + 9.57 × ln(creatinine) + 6.43. Range 6–40. Predicts 3‑month mortality in chronic liver disease.

  • MELD‑Na (2016)

    Adds serum sodium - a sodium <137 mmol/L increases the score. Better prognostic accuracy; adopted by UNOS in the US and increasingly used in the UK.

  • MELD 3.0 (2023)

    Further refinement including sex and albumin, reducing under‑scoring in women. Adopted by UNOS in 2023.

  • UKELD

    The UK NHSBT transplant listing score - INR, creatinine, bilirubin and sodium. UKELD ≥49 has historically been the routine listing threshold.

  • PELD (paediatric)

    For children under 12: albumin, INR, bilirubin, growth failure and age <1. Used by NHSBT for paediatric transplant listing.

  • Child‑Pugh (A/B/C)

    The older classification - bilirubin, albumin, INR, ascites and encephalopathy. Still used alongside MELD/UKELD, especially in surgical risk.

  • Variant‑syndrome routes

    HCC in Milan, hepatopulmonary syndrome, portopulmonary hypertension, refractory ascites, recurrent variceal bleeding, PSC cholangitis, some metabolic disease - listing at UKELD <49.

  • Consultation only

Interpretation

What the numbers actually mean.

MELD and UKELD are prognostic tools, not diagnoses. Read alongside your bloods, imaging and clinical picture - a single snapshot is a poor guide, trend matters.

  • A score is not a diagnosis

    MELD and UKELD grade severity in known liver disease. They do not tell you the cause, and they do not replace imaging, endoscopy or histology.

  • MELD <10 - mild

    Roughly <5% 3‑month mortality on the score alone. Most patients are managed in outpatient hepatology with regular re‑scoring.

  • MELD 10–19 - moderate

    Roughly 6–20% 3‑month mortality. Closer follow‑up, often variceal surveillance, and consideration of transplant referral if trending up.

  • MELD 20–29 - severe

    20–50% 3‑month mortality. Transplant assessment territory, and TIPS or major surgery need very careful risk discussion.

  • MELD ≥30 - very severe

    >50% 3‑month mortality on the score alone. Urgent transplant centre input; non‑transplant surgery is generally avoided.

  • UKELD <49 - routine listing unlikely

    Below 49 you are usually not listed on the routine UK criteria - but variant syndromes can and do change that at MDT.

  • UKELD ≥49 - eligible for listing

    At or above 49 you are typically eligible for listing, subject to full workup and MDT approval at a UK transplant centre.

  • Re‑score, don’t rely on one snapshot

    MELD and UKELD move with your bloods. A single number in isolation is a poor guide - trend matters as much as the value.

  • Red flags

    New jaundice, confusion, GI bleeding, tense ascites or a sudden jump in MELD are reasons for same‑day hospital assessment, not a clinic booking.

Reading your hepatology report

Your report in four parts. Read the last one first.

Whichever score is used, the letter from your hepatologist tends to keep to the same shape.

A UK consultant hepatologist reviewing MELD and UKELD scores in clinic

A quiet reminder

Score language is precise and can read coldly - we translate it for you.

If you would like us to talk you through your report before your review, just ask.

  1. 01 Header

    Underlying diagnosis and scores today

    The liver diagnosis, today’s MELD, MELD‑Na, MELD 3.0 (where used), UKELD and Child‑Pugh - with the bloods they were calculated from.

  2. 02 Technique

    How the scores were calculated

    Which bloods and which formula (original MELD vs MELD‑Na vs MELD 3.0), the NHSBT UKELD calculator, and any imputations for missing values.

  3. 03 Findings

    Clinical context around the number

    Ascites, encephalopathy, varices grade, HCC status against Milan criteria, and any variant syndrome that changes the listing route.

  4. 04 Impression

    Plan, re‑score cadence, MDT trigger

    Read this first: what your MELD/UKELD means for you, whether transplant assessment is triggered, and when the next bloods and review are due.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for private hepatology varies by insurer. Formal transplant listing itself is NHS at a tertiary centre - private cover typically applies to the outpatient assessment and imaging, not the listing decision.

Frequently asked

Everything we get asked about MELD and UKELD.

Quick answers on formulas, thresholds, UK listing, and how MELD relates to Child‑Pugh.

  • What is the MELD score?

    MELD (Model for End‑Stage Liver Disease) is a validated prognostic score for chronic liver disease. The original formula uses bilirubin, INR and creatinine, giving a value between 6 and 40 - the higher the score, the worse the 3‑month mortality.

  • How is MELD different from MELD‑Na and MELD 3.0?

    MELD‑Na (2016) adds serum sodium, because low sodium worsens prognosis. MELD 3.0 (2023) adds sex and albumin, correcting a systematic under‑scoring in women. Both are refinements - UNOS in the US now uses MELD 3.0.

  • What is UKELD and how is it different?

    UKELD is the UK NHSBT transplant listing score - INR, creatinine, bilirubin and sodium. It is the score UK transplant units actually use to decide listing, with MELD‑Na as complementary information.

  • What UKELD score do I need to be listed for a liver transplant?

    UKELD ≥49 has historically been the routine listing threshold in the UK, subject to MDT approval at a transplant centre. Below 49, listing is still possible via variant syndromes - HCC in Milan, hepatopulmonary syndrome, portopulmonary hypertension, refractory ascites, recurrent variceal bleeding, PSC cholangitis and certain metabolic diseases.

  • Is MELD the same as Child‑Pugh?

    No. Child‑Pugh (class A, B or C) is an older classification using bilirubin, albumin, INR, ascites and encephalopathy. It is still used, especially for surgical risk, but MELD and UKELD are better at ranking transplant priority.

  • What does MELD 20 or 30 mean for prognosis?

    On the score alone, MELD 20–29 carries roughly 20–50% 3‑month mortality, and MELD ≥30 carries >50%. These are population estimates - your individual risk depends on cause, complications and how the score is trending.

  • How much does a private MELD/UKELD assessment cost in the UK?

    A consultant hepatology consultation is roughly £250–£450, with repeat bloods £120–£240. MRE liver stiffness sits at £850–£1,400 and CT liver volumetry at £600–£900. Formal transplant assessment is NHS / tertiary.

  • Is MELD used for children?

    No - children under 12 use PELD, which is based on albumin, INR, bilirubin, growth failure and age <1 year. NHSBT uses PELD for paediatric transplant listing.

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