ACLF-3 Liver Transplantation: Can TAM or SALT-M Reliably Decide Who Should Be Transplanted?: Liver Transplantation | September 2026

What Did the Study Find?

This international study evaluated 336 patients transplanted with ACLF grade 3 across nine cohorts to assess the TAM and SALT-M scores for predicting post-transplant outcomes.

Overall 1-year post-LT survival was 75.3%, confirming substantial survival despite severe ACLF.

Both TAM and SALT-M were associated with 1-year mortality.

However, predictive discrimination was modest: AUROC 0.61 and 0.64, respectively.

TAM ≥3 identified a high-risk group with only 42.9% 1-year survival, versus 79.0% below this threshold.

SALT-M >25 similarly identified patients with 46.9% vs 78.7% survival.

Respiratory failure (PaO₂/FiO₂ ≤200) emerged as an important mortality predictor.

Why Does It Matter?

Transplant selection in ACLF-3 requires balancing urgency against the likelihood of meaningful post-transplant survival. A simple score capable of identifying futility would therefore be highly valuable.

GastroAGI Takeaway

Neither TAM nor SALT-M is accurate enough to determine transplant candidacy alone. High scores may flag a small group requiring particularly careful assessment, but should support—not replace—multidisciplinary transplant judgment. Importantly, ~75% 1-year survival reinforces that ACLF-3 itself should not be considered transplant futility.