PELD Cr Calculator

Pediatric End-Stage Liver Disease with creatinine (under age 12). Units align with common reference tools: albumin g/L, bilirubin and creatinine µmol/L. Educational use only; verify allocation scores with OPTN policy and your transplant center.

Age (years)

Albumin (g/L)

Bilirubin (µmol/L)

INR

Creatinine (µmol/L)

Disclaimer: This calculator is for education and discussion only. It does not replace the OPTN allocation system, transplant program review, or clinical judgment. Growth scoring in production allocation uses LMS-based CDC Z-scores from measured height and weight; this page uses a clinician-indicated growth failure flag. Refer to HRSA/OPTN materials for authoritative rules.

How PELD Cr is calculated

The Pediatric End-Stage Liver Disease score with creatinine (PELD Cr) prioritizes liver transplant candidates under 12 years old in the United States. It replaced the earlier PELD model in OPTN policy (July 2023 framework). Always follow current OPTN policy and local guidance for allocation decisions.

Clinical inputs

Age under 12 years and growth failure beyond -2 SD (by CDC growth charts) align with OPTN intent.
Albumin (g/L), total bilirubin (µmol/L), INR, and creatinine (µmol/L) match typical chemistry reporting used alongside reference tools such as MDCalc.
Dialysis or 24 hours of CVVHD within 7 days before the creatinine sample triggers creatinine assignment per OPTN rules (see references).

Scoring structure (educational)

The allocation model combines logarithmic laboratory terms with age and growth-related terms, then applies OPTN policy scaling: (inner sum + 1.5287) × 10 + 2.82, rounded to the nearest whole number, with a minimum score of 6. Bilirubin, INR, and albumin are floored at 1.0 in their respective policy units (mg/dL for bilirubin and creatinine, g/dL for albumin, INR as a ratio). Creatinine may be assigned to 1.3 mg/dL when thresholds in policy are met.

Inner sum terms commonly quoted for the updated model include 0.480×ln(bilirubin) + 1.857×ln(INR) - 0.687×ln(albumin) + 0.961×ln(creatinine), plus an infant age contribution when age is under 1 year, plus a growth-related contribution when growth failure criteria are met. Official allocation software uses LMS-based CDC Z-scores for height and weight as continuous inputs; this educational tool uses a binary growth indicator when growth failure beyond -2 SD is present on chart review.

References

What is PELD Cr?

PELD Cr is the Pediatric End-Stage Liver Disease score that incorporates serum creatinine together with standard liver-related laboratory measures. In United States organ allocation policy, it is the pediatric counterpart used for prioritizing liver transplant candidates who are under 12 years of age. Adolescents and adults at 12 years and older follow MELD-based allocation instead. The score estimates waitlist mortality risk using recent laboratory values and a small set of clinical modifiers so that the sickest listed children receive higher priority when organs are allocated.

The creatinine-inclusive formulation replaced an earlier PELD specification so that renal dysfunction in the setting of liver disease receives explicit weight in the model. Policy details, coefficient updates, and rounding rules are maintained by the Organ Procurement and Transplantation Network and should always be verified against current policy text when the numeric result will drive listing or organ offers.

Who it applies to

PELD Cr is intended for pediatric liver transplant candidates below age 12. The calculator enforces that age range. Infants and toddlers receive additional consideration through an age term when under one year. Growth status also enters the model because chronic liver disease impairs linear growth and weight gain; malnutrition and stunting correlate with worse outcomes independent of raw bilirubin alone.

Laboratory inputs

Total bilirubin reflects cholestasis and severity of hepatic dysfunction. INR captures synthetic liver function and coagulopathy. Serum albumin reflects nutritional status, portal hypertension, and hepatic synthetic capacity. Creatinine proxies renal function, which often declines in advanced liver disease, acute kidney injury, or fluid shifts.

Many hospitals report bilirubin and creatinine in µmol/L and albumin in g/L; conversion to the units used inside the model (mg/dL for bilirubin and creatinine, g/dL for albumin) is part of the calculation pipeline.

Dialysis and creatinine assignment

When a child is receiving renal replacement therapy, measured creatinine may underestimate renal risk. Policy therefore assigns creatinine to a fixed value when specific criteria are met, such as two or more dialysis sessions or at least 24 hours of continuous venovenous hemofiltration in the days before the sample, aligned with the timeframe described in current OPTN rules. When measured creatinine is above a stated threshold, creatinine may also be assigned to that same fixed value rather than the raw lab number. These assignment rules exist so the score does not understate risk in patients whose labs look artificially benign.

Age and growth terms

An extra positive contribution is applied for candidates under one year of age, reflecting higher waitlist mortality in young infants with end-stage liver disease. A growth-related contribution applies when the patient meets growth failure criteria relative to age and sex. Full allocation systems may use continuous growth chart Z-scores from CDC LMS methodology; educational calculators often simplify this to a binary indicator when height or weight is more than two standard deviations below the mean. Binary simplification can differ slightly from the official integrated score, which matters only when exact listing parity with the national calculator is required.

How the mathematics is structured

The model is built from natural logarithms of laboratory values after policy-defined floors and unit conversions. Commonly quoted laboratory terms (before policy intercept and outer scaling) follow this pattern:

0.480 × ln(bilirubin) + 1.857 × ln(INR) − 0.687 × ln(albumin) + 0.961 × ln(creatinine)

Additional positive increments may apply for infancy and for growth failure as described above. Bilirubin, INR, and albumin are not allowed to fall below minimum numeric floors in their policy units, which prevents logarithms from drifting toward negative infinity when values are very low. Creatinine uses a small positive floor when assignment rules do not apply, so the logarithmic term remains defined.

The linear predictor is then scaled with policy constants: the inner sum plus an intercept (often cited as 1.5287 in educational materials), multiplied by ten, plus an age-adjusted mortality offset (often cited as 2.82). The result is rounded to the nearest whole number. A minimum total score applies so that listed candidates retain baseline priority despite favorable labs on a single draw.

Interpreting the number

Higher PELD Cr values indicate higher estimated risk of death on the waitlist under the statistical model used in allocation. The score is not a bedside prognostic tool for every clinical scenario; it is tuned for fair organ distribution among listed candidates with standardized laboratory intervals. Sudden improvement in labs can lower the score, while acute deterioration raises it. Teams typically update laboratory data on a schedule mandated by policy so the listed priority reflects current physiology.

Clinical and operational caveats

Policy churn: Intercepts, coefficients, and dialysis definitions can change when OPTN updates rules. Always confirm critical listing decisions with the authoritative OPTN PELD calculator and governing policy sections.

Growth modeling: Simplified binary growth inputs in teaching tools may diverge marginally from the national implementation that consumes continuous Z-scores.

Laboratory timing: Hemolysis, obstruction of biliary drains, recent transfusion, or intravenous albumin can distort individual analytes; clinical teams address artifact before submitting values used for allocation.

Scope: PELD Cr summarizes laboratory and selected pediatric modifiers. It does not replace multidisciplinary judgment about timing of transplant, suitability, or management of complications.

Appropriate use of this calculator

This interface is suited to education, trainee understanding, and approximate verification of manually transcribed values. For formal candidate registration, rank ordering, and audit-sensitive documentation, use the official OPTN tools and workflows endorsed by your transplant program.

CalcMD.

PELD Cr (Pediatric End-Stage Liver Disease)

PELD Cr calculator for pediatric liver transplant candidates under 12: bilirubin, INR, albumin, creatinine, infant and growth terms, OPTN-style scaling and minimum score. For education; use OPTN for listing.