This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
The PELD score (Pediatric End-Stage Liver Disease) was introduced in the United States in 2002 to rank children under 12 years old on the liver transplant waiting list. It is the pediatric counterpart of the MELD score used for adults and teenagers. It was derived from data from the Studies of Pediatric Liver Transplantation (SPLIT) registry to predict the risk of death or of becoming too sick within three months.
The formula
PELD = 4.80 × ln(bilirubin, mg/dL) + 18.57 × ln(INR) − 6.87 × ln(albumin, g/dL) + 4.36 if under 1 year + 6.67 if growth failure
The result is often written as 10 × (0.480 ln bilirubin + 1.857 ln INR − 0.687 ln albumin + 0.436 age + 0.667 growth). Lab values below 1 are set to 1 so that the logarithms do not go negative. The calculator accepts bilirubin in µmol/L or mg/dL (divide µmol/L by 17.1) and albumin in g/L or g/dL.
- Age: the 4.36 points apply to children listed before their first birthday and were kept until age 2 in the original allocation rules.
- Growth failure: height or weight more than 2 standard deviations below the mean for age and sex.
Example
An infant with bilirubin 3 mg/dL (51 µmol/L), INR 1.5 and albumin 3.0 g/dL (30 g/L), without growth failure:
4.80 × ln 3 + 18.57 × ln 1.5 − 6.87 × ln 3 + 4.36 = 5.27 + 7.53 − 7.55 + 4.36 = 9.6, rounded to 10.
Reading the score
Higher scores mean more severe liver disease and a greater risk of death without a transplant. The score can be negative in a child with near-normal tests. There are no fixed bands; the calculator’s labels only place the result on the scale.
PELD-Cr and other countries
In 2023 the US Organ Procurement and Transplantation Network replaced the original PELD with PELD-Cr, which adds creatinine and updates the coefficients, and moved adolescents to MELD 3.0. Many other countries, including France, allocate pediatric livers under their own national rules. The original PELD remains widely cited in research and teaching.
Limits
INR rises with vitamin K deficiency, common in cholestatic infants, and albumin falls with malnutrition or protein loss. Diseases such as biliary atresia, metabolic disorders or liver tumors may need exception points because the score underestimates their urgency. Transplant decisions belong to a pediatric liver team.