What criteria and scoring systems are used to select liver transplant candidates and prioritize listing?

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Multiple Choice

What criteria and scoring systems are used to select liver transplant candidates and prioritize listing?

The main idea is that liver transplant listing uses two linked concepts: tumor-specific eligibility and a severity-based priority score. For hepatocellular carcinoma, the Milan criteria specify what tumor burden is considered acceptable for transplantation: a single tumor up to 5 cm, or up to three tumors each no larger than 3 cm, with no macrovascular invasion and no evidence of extrahepatic spread. Meeting these tumor criteria helps identify patients whose post-transplant outcomes are favorable. To decide who gets listed sooner, the MELD score is used. MELD estimates 3-month mortality risk based on lab values—bilirubin, INR, and creatinine—and higher scores mean higher priority on the waiting list. For HCC patients, many programs grant MELD exception points to reflect the risk of tumor progression and to prevent patients from dying on the waitlist while their liver function remains relatively preserved. A complete evaluation goes beyond tumor status or MELD alone and includes comorbidity and overall transplant risk, such as cardiovascular health, renal function, nutrition, infection risk, and psychosocial factors. Other statements don’t fit because listing decisions rely on more than functional status, MELD is used to prioritize listing rather than to select donors, and there are defined criteria for HCC eligibility rather than none existing.

The main idea is that liver transplant listing uses two linked concepts: tumor-specific eligibility and a severity-based priority score. For hepatocellular carcinoma, the Milan criteria specify what tumor burden is considered acceptable for transplantation: a single tumor up to 5 cm, or up to three tumors each no larger than 3 cm, with no macrovascular invasion and no evidence of extrahepatic spread. Meeting these tumor criteria helps identify patients whose post-transplant outcomes are favorable.

To decide who gets listed sooner, the MELD score is used. MELD estimates 3-month mortality risk based on lab values—bilirubin, INR, and creatinine—and higher scores mean higher priority on the waiting list. For HCC patients, many programs grant MELD exception points to reflect the risk of tumor progression and to prevent patients from dying on the waitlist while their liver function remains relatively preserved. A complete evaluation goes beyond tumor status or MELD alone and includes comorbidity and overall transplant risk, such as cardiovascular health, renal function, nutrition, infection risk, and psychosocial factors.

Other statements don’t fit because listing decisions rely on more than functional status, MELD is used to prioritize listing rather than to select donors, and there are defined criteria for HCC eligibility rather than none existing.

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