Transplant Listing MELD Threshold — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyTransplant Listing MELD ThresholdRACP Adult Medicine

A 68-year-old man with known cirrhosis and previous SBP presents for discussion of liver transplant eligibility. He has a current MELD-Na score of 18. He abstained from alcohol 14 months ago. He has no HCC. At what MELD-Na threshold is liver transplant listing generally considered?

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Correct answer: E — MELD-Na ≥20

Liver transplant listing is generally considered when the predicted 3-month mortality without transplant exceeds the risk of transplant surgery. This typically corresponds to a MELD-Na score of ≥15–20 (though the exact threshold varies between transplant programmes). At MELD-Na 18, this patient is approaching the listing threshold. Additional indications for transplant listing regardless of MELD include HCC within criteria, hepatopulmonary syndrome, intractable pruritus, and recurrent cholangitis. The patient's alcohol abstinence of 14 months meets the minimum psychosocial assessment requirements for most Australian programmes.

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