Liver Transplant Contraindications — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyLiver Transplant ContraindicationsRACP Adult Medicine

A 40-year-old man with chronic hepatitis C cirrhosis (Child-Pugh B) and a MELD-Na score of 15 is being considered for liver transplantation. His HCV has been cured with DAA therapy (SVR confirmed). Which of the following is an absolute contraindication to liver transplantation?

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Correct answer: C — Age >60

Absolute contraindications to liver transplantation include: active extrahepatic malignancy (except non-melanoma skin cancer and some early HCC within criteria), active sepsis/uncontrolled systemic infection, severe cardiopulmonary disease precluding surgery, active substance abuse (active alcohol/drug use), anatomical abnormalities precluding transplant, and irreversible neurological impairment. Active HCV is NOT a contraindication (it can be treated pre- or post-transplant with DAAs with excellent SVR rates). Age alone is not an absolute contraindication, though outcomes are poorer >70 years. Previous abdominal surgery increases surgical complexity but is not a contraindication.

Reference: TSANZ – 2024 – Liver Transplant Consensus; eTG – 2025 – Gastrointestinal