What are the key indications for referring a patient for liver transplantation in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Key indications for referring a patient for liver transplantation in primary care include:

  • Development of decompensated liver disease, evidenced by symptoms such as ascites, hepatic encephalopathy, or gastrointestinal haemorrhage, which requires immediate referral to a hepatologist or gastroenterologist with an interest in hepatology .
  • Diagnosis of cirrhosis, especially when complications arise or the patient is at high risk of complications, should prompt referral to a specialist hepatology centre .
  • Patients with a Model for End-Stage Liver Disease (MELD) score of 12 or more, indicating high risk of complications, should be considered for specialist referral and potential transplantation assessment .
  • Presence of hepatocellular carcinoma (HCC) in the context of cirrhosis or chronic liver disease may also necessitate specialist referral for transplantation evaluation ,.

In summary, primary care should refer patients with advanced liver disease manifestations, including decompensation, cirrhosis with complications or high MELD scores, and those with HCC, to specialist hepatology services for assessment for liver transplantation ,.

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