PELD Score
Estimate Pediatric End-Stage Liver Disease urgency from bilirubin, INR, albumin, age, and growth failure using policy-aware guardrails.
Last reviewed: February 25, 2026
Clinical disclaimer
How PELD works
PELD = 10 × (0.480×ln(bilirubin mg/dL) + 1.857×ln(INR) − 0.687×ln(albumin g/dL) + 0.436×growth failure + 0.667×age <1y). This calculator rounds to the nearest integer and applies guardrails for implausible inputs.
Labs, units, and guardrails
- Use mg/dL for bilirubin and g/dL for albumin. Confirm INR from a valid lab run (watch for anticoagulants, lab artifacts).
- Growth failure: weight or height z-score < −2 counts as positive. Ensure growth data is current and accurate.
- Use lab timing that matches your transplant workflow; recent interventions (e.g., albumin infusion) can affect interpretation.
- We apply floors to avoid log of zero/negative and cap extreme inputs to reduce distortion; official allocation systems may apply additional policy-specific rules.
Operational workflow (clinic or inpatient)
- Verify current lab set, units, and growth inputs before calculation.
- Calculate PELD and compare with prior values to assess trajectory.
- Cross-check with current complications (ascites, encephalopathy, bleeding, infection risk).
- Document whether score change alters listing urgency, monitoring cadence, or care setting.
- Align final decisions with active OPTN/UNOS policy and transplant center protocol.
Clinical interpretation and policy reminders
Higher scores reflect greater transplant urgency. This calculator is informational; always defer to current OPTN/UNOS policy and your transplant center’s system for official listing scores, rounding, and exception handling.
- Check for policy updates on rounding, floors, and allowable lab age.
- Consider exception pathways for conditions not captured fully by the formula; transplant centers handle requests per policy.
When to escalate
- Rising PELD, worsening synthetic function, or growth failure should prompt transplant/hepatology review.
- Red flags: encephalopathy, refractory ascites, GI bleeding, severe coagulopathy, or rapid bilirubin rise—escalate immediately.
- Coordinate nutrition (enteral/parenteral as needed) and infection prophylaxis; address pruritus, fat-soluble vitamin deficits, and portal hypertension complications.
Immediate escalation triggers
- Rapid score rise with worsening synthetic function or portal hypertension complications.
- Acute decompensation signs (encephalopathy, severe bleeding, refractory ascites, infection concern).
- Large score/clinical mismatch suggesting unreliable input timing or rapidly changing physiology.
- Potential need for exception pathway consideration not captured by formula.
Pediatric specifics and follow-up
- Trend growth, mid-upper arm circumference, and development; malnutrition can accelerate decline and affect transplant readiness.
- Vaccinations and infection prevention (including central line care if applicable) are essential while awaiting transplant.
- Revisit labs per center protocol; timing relative to interventions (e.g., albumin infusions) can affect results.
Common failure modes
- Using stale labs or mixed-timepoint values and treating the result as current urgency.
- Ignoring growth-failure criteria because z-scores were not updated with recent measurements.
- Treating the calculator output as official allocation score without policy-system verification.
- Missing rapid clinical deterioration because focus stays on score changes alone.
Handoff template
- Current PELD value with exact lab/growth inputs and collection times.
- Trajectory vs prior scores and key clinical events since last review.
- Current complications and immediate stabilization priorities.
- Listing/prophylaxis/monitoring plan aligned with transplant center workflow.
- Escalation trigger and next reassessment timeline.
Related tools
- Pediatric eGFR for renal dosing and organ interactions.
- Pediatric Blood Volume and Transfusion Volume for peri-procedural planning.
References
FAQs
Total bilirubin, INR, albumin, age <1 year, and growth failure (weight or height z-score < −2). This tool includes unit conversion and rounding guardrails.
Yes. Low-risk combinations can yield negative values; some systems floor at 0 for display. Allocation policies control the official reported score.
Use the most recent, reliable values per current OPTN/UNOS policy and your transplant center’s workflow. Confirm units (mg/dL, g/dL) and timing.
This implements the widely referenced formula with common rounding guardrails. Always defer to active OPTN/UNOS policy and transplant center calculations for listing and allocation decisions.
Recalculate when new qualifying labs or growth data are available and whenever clinical trajectory changes. Trending over time is more informative than a single isolated score.
Use policy-consistent lab timing from your transplant workflow. Albumin values drawn soon after infusion may not reflect baseline synthetic function and can shift score interpretation.
Yes. Exception mechanisms may apply when disease burden is not fully represented by formula variables. Decisions should be coordinated with the transplant team and current policy.