PELD Score (Pediatric End-Stage Liver Disease) (younger than 12)

Compute classic creatinine-free PELD for children under 12 using albumin (g/L), bilirubin (µmol/L), INR, infant status, and growth failure. Logarithmic formula with SI-friendly units; educational only.

PELD Score (younger than 12)

Classic pediatric end-stage liver disease score without creatinine. Inputs match common panels: albumin g/L, bilirubin µmol/L. Educational use only; US allocation uses PELD Cr with creatinine under current OPTN policy.

Age (years)

Albumin (g/L)

Bilirubin (µmol/L)

INR

Disclaimer: Educational calculator only. US pediatric liver allocation uses PELD Cr under current OPTN rules. Confirm urgency scores with official tools and your transplant team.

Classic PELD (under age 12)

This is the historic Pediatric End-Stage Liver Disease score without creatinine, expressed with natural logarithms of serum bilirubin (mg/dL), INR, and albumin (g/dL), plus binary contributions for infants under 1 year of age and for growth failure.

Formula

PELD = 10 × [ 0.480×ln(bilirubin) + 1.857×ln(INR) − 0.687×ln(albumin) + 0.436×I(<1 yr) + 0.667×I(growth failure) ]

Multiplying out gives the equivalent form often quoted in summaries: 4.80×ln(bilirubin) + 18.57×ln(INR) − 6.87×ln(albumin) + 4.36 when age is under 1 year + 6.67 when growth failure is present. The score is rounded to the nearest whole number.

Units on this page

Age in years (strictly less than 12 for this calculator).
Albumin in g/L (divide by 10 internally to obtain g/dL).
Total bilirubin in µmol/L (divide by 17.1 to obtain mg/dL).
INR as reported from the laboratory.

Laboratory floors for ln (educational)

Bilirubin (mg/dL), albumin (g/dL), and INR are floored at 1.0 before taking logarithms, consistent with common UNOS-style educational implementations.

United States allocation note

OPTN policy now uses PELD with creatinine (PELD Cr) for pediatric liver allocation. Use this classic form when you need the creatinine-free model (for example to match older references or specific teaching scenarios). For listing decisions, follow current OPTN tools and your transplant center.

References

What is PELD?

The Pediatric End-Stage Liver Disease (PELD) score is a severity index developed for pediatric candidates with chronic liver failure. It combines objective laboratory measures with two pediatric-specific clinical modifiers so that illness severity can be summarized in a single number. In educational tools and historical transplant-allocation discussions, the classic form uses serum bilirubin, prothrombin-related coagulation (expressed as INR), serum albumin, whether the child is under one year of age, and whether there is growth failure relative to population norms.

This calculator applies to candidates younger than 12 years. Adolescents 12 and older have historically been modeled with adult-type allocation scores (for example MELD or MELD-Na in United States policy contexts), which is why age boundaries matter both clinically and when comparing scores across references.

Why the score exists

Children with end-stage liver disease span a wide range of diagnoses (cholestatic diseases, metabolic liver disease, acute liver failure chronicles, and others). Severity is not captured by a single lab value: hyperbilirubinemia may dominate in cholestasis, while synthetic dysfunction may appear through INR and albumin. Infants and young children also have unique risks and trajectory compared with older children. The PELD formulation attempts to integrate these dimensions into a structured model rather than relying on informal gestalt alone.

Growth failure is included because chronic liver disease in childhood commonly interferes with nutritional status, absorption, and linear growth. Even when bilirubin or INR changes are modest, poor growth can signal substantial chronic morbidity in the pediatric population.

Classic PELD without creatinine

The version implemented here is the classic logarithmic PELD model without creatinine. Natural logarithms are applied to bilirubin (mg/dL), INR, and albumin (g/dL). Two binary indicators add fixed contributions: one for age under one year and one for growth failure defined as height or weight more than two standard deviations below the mean for age and sex on standard growth charts.

In expanded form, the relationship is often written as:

PELD = 10 × [ 0.480 × ln(bilirubin) + 1.857 × ln(INR) − 0.687 × ln(albumin) + 0.436 × I(<1 yr) + 0.667 × I(growth failure) ]

Algebraically, multiplying the coefficients through by 10 yields an equivalent display form:

PELD = 4.80×ln(bilirubin) + 18.57×ln(INR) − 6.87×ln(albumin) + 4.36 (when age is under one year) + 6.67 (when growth failure is present).

The result is rounded to the nearest whole number.

Laboratory inputs and clinical meaning

Total bilirubin

Elevated bilirubin reflects cholestasis or hepatocellular injury severity in many pediatric liver diseases. Because the score uses a logarithmic transform, very large bilirubin values increase the score, but the increase scales sublinearly.

INR

INR summarizes extrinsic pathway coagulation changes often associated with decreased hepatic synthesis of clotting factors. Higher INR implies worse synthetic liver function in many clinical contexts.

Albumin

Albumin is influenced by hepatic synthesis, nutritional intake, inflammation, and systemic illness. Lower albumin contributes to a higher PELD value through the negative coefficient on ln(albumin).

Age under one year

A binary contribution recognizes that infant liver transplant candidates may face distinct waiting-list mortality and perioperative considerations compared with older children, even when some laboratory values overlap.

Growth failure

The growth-failure indicator captures a pediatric-specific burden of disease that may not be reflected in bilirubin or INR alone. Assignment should follow formal growth-chart methodology rather than impression alone.

Units and conversions on this calculator

This tool accepts albumin in g/L and total bilirubin in µmol/L, which are common on chemistry panels outside the United States. Internally, albumin is converted to g/dL by dividing by 10, and bilirubin is converted to mg/dL using the conventional factor (µmol/L divided by 17.1). INR is entered as reported by the laboratory.

Handling low laboratory values (floors)

Because ln(x) is undefined at zero and extremely sensitive near zero, bilirubin (mg/dL), albumin (g/dL), and INR are floored at 1.0 before logarithms are taken. This matches common educational implementations aligned with historical UNOS-style teaching examples. Small differences in flooring rules across institutions can produce minor score differences at the margins.

United States allocation context

For pediatric liver allocation in the United States, policy has evolved over time. Contemporary OPTN policy commonly emphasizes models that incorporate creatinine for pediatric candidates (often referred to as PELD Cr in educational materials). The classic creatinine-free PELD remains useful for teaching, historical comparison, and calculators that intentionally mirror older published coefficient sets. It should not be mistaken for the exact operational calculator used by every transplant program today.

Interpretation and limits

PELD summarizes selected facets of illness severity. It does not replace transplant-team judgment, imaging, hemodynamics, transplant-contraindication review, or individualized psychosocial and logistical factors. Labs fluctuate with infection, bleeding, recent transfusions, nutritional interventions, and assay variability. Any calculated score should be interpreted alongside clinical trajectory and local protocols.

Scores can differ if charted laboratory units are misread, if direct versus total bilirubin is confused, or if growth-failure criteria are applied inconsistently. When feasible, use contemporaneous labs obtained under stable clinical conditions and consistent assay methods.