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PELD-Cr (Pediatric End-Stage Liver Disease with Creatinine)

Creatinine-augmented PELD for waitlist mortality risk.

PELD-Cr (Pediatric End-Stage Liver Disease with Creatinine)
Total bilirubin
mg/dL
INR
Albumin
Serum creatinine
Dialysis >=2 times in past week (or 24h CVVHD)
If yes, creatinine is set to 4.0 mg/dL.
Age <1 year at listing
Growth failure (<2 standard deviations)
Complete the fields above to see the result.

When to use

  • Estimating waitlist mortality risk and transplant priority in children <12 years, incorporating renal function.

Formula

PELD-Cr = 10 x [0.480*ln(bilirubin) + 1.857*ln(INR) - 0.687*ln(albumin) + 0.961*ln(creatinine) + 0.436*(age<1) + 0.667*(growth failure)]. Bilirubin and INR floored at 1; creatinine bounded 0.1-4.0 (4.0 if on dialysis).

Pearls and pitfalls

  • This is the creatinine-augmented PELD variant; the official OPTN allocation score adopted in 2023 uses a more complex linear-spline model that also includes serum sodium.
  • Bilirubin, INR and albumin are handled with the same value floors as the classic PELD.

References

  1. McDiarmid SV, et al. Development of a pediatric end-stage liver disease (PELD) score. Transplantation. 2002;74(2):173-81.
  2. Hsu EK, et al. Improving the predictive ability of the PELD score for young children awaiting liver transplant. Am J Transplant. 2021;21(1):222-31.