100+ Free ABIM Tx Hepatology Practice Questions

Pass your ABIM Transplant Hepatology Certification exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

~85-95% Pass Rate

100+ Questions

100% Free

1 / 10

Question 1

Score: 0/0

Which laboratory value is NOT a component of the MELD-Na score used for liver transplant waitlist prioritization?

Serum creatinine

Total bilirubin

INR

Serum albumin

to track

2026 Statistics

Key Facts: ABIM Tx Hepatology Exam

~$2,990

ABIM TH Exam Fee

ABIM 2026

~180 MCQs

Exam Length

~9 hr exam day, 2 sessions

1 yr

TH Fellowship

ACGME (or combined 3-yr path)

Every 2 years

Exam Frequency

Biennial cycle

85-95%

First-Time Pass Rate

ABIM historical

~9,500/yr

US Liver Transplants

OPTN

Transplant Hepatology is a small but high-impact ABIM subspecialty serving the ~9,500 US liver transplants performed annually at ~140 centers (OPTN). The exam emphasizes the 2023 NAFLD-to-MASLD Delphi nomenclature, resmetirom (Rezdiffra, FDA March 2024 first-ever MASH therapy for F2-F3 fibrosis), elafibranor/seladelpar (2024 FDA 2nd-line PBC), bulevirtide (Hepcludex 2023 HDV), MELD-Na waitlist prioritization, the move toward early transplant for alcohol-associated hepatitis without mandatory 6-month abstinence (Mathurin/STROKE trials), and systemic HCC therapy (atezolizumab + bevacizumab IMbrave150, durvalumab + tremelimumab HIMALAYA STRIDE). Post-transplant content emphasizes tacrolimus + MMF maintenance, renal-sparing everolimus, Banff rejection grading, DSA/C4d antibody-mediated rejection, and infection timing (<1 mo nosocomial vs 1-6 mo CMV/PCP/fungal vs >6 mo community). Board-certified transplant hepatologists command a significant compensation premium over general hepatologists.

Sample ABIM Tx Hepatology Practice Questions

Try these sample questions to test your ABIM Tx Hepatology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which laboratory value is NOT a component of the MELD-Na score used for liver transplant waitlist prioritization?

A.Serum creatinine

B.Total bilirubin

C.INR

D.Serum albumin

Explanation: MELD-Na uses creatinine, bilirubin, INR, and sodium. Albumin is part of Child-Pugh but NOT MELD-Na. MELD-Na is capped at 40; higher scores = higher waitlist priority.

2A cirrhotic patient with ascites, albumin 2.6 g/dL, bilirubin 3.5 mg/dL, INR 1.9, and mild encephalopathy has which Child-Pugh class?

A.Child-Pugh A

B.Child-Pugh B

C.Child-Pugh C

D.Child-Pugh D

Explanation: Child-Pugh scoring sums 5 variables (bilirubin, albumin, INR, ascites, encephalopathy). This patient: bilirubin 3.5 = 2, albumin 2.6 = 2, INR 1.9 = 2, ascites = 2, HE grade 1-2 = 2. Total ~10 = Child-Pugh C (>=10). A = 5-6, B = 7-9, C = 10-15.

3What is the maximum MELD-Na score assigned for liver transplant allocation?

A.30

B.35

C.40

D.45

Explanation: MELD-Na is capped at 40. Scores above this do not confer additional waitlist priority, though the calculated score may exceed 40.

4Which of the following is FIRST-LINE primary prophylaxis for medium-to-large esophageal varices in a patient with compensated cirrhosis?

A.TIPS

B.Nonselective beta-blocker (propranolol, nadolol, or carvedilol) OR endoscopic variceal ligation

C.Octreotide infusion

D.Endoscopic sclerotherapy

Explanation: Per AASLD, primary prophylaxis for medium-large varices is either a nonselective beta-blocker (propranolol, nadolol, or carvedilol) OR endoscopic variceal ligation (EVL). Both have class I support. Carvedilol is preferred in many centers for superior HVPG reduction.

5In acute variceal hemorrhage, which vasoactive agent is given as an adjunct to endoscopic therapy?

A.Octreotide

B.Nitroprusside

C.Dobutamine

D.Vasopressin alone

Explanation: Octreotide (a somatostatin analog) 50 mcg IV bolus then 50 mcg/hr infusion for 3-5 days is adjunctive to endoscopic variceal ligation. Terlipressin is the preferred vasoactive agent in Europe. Ceftriaxone prophylaxis is also indicated.

6A cirrhotic patient with ascites has diagnostic paracentesis showing ascitic PMN count of 320/mm^3. What is the diagnosis and empiric therapy?

A.SBP; empiric ceftriaxone 2 g IV daily

B.Tuberculous peritonitis; rifampin/isoniazid/pyrazinamide/ethambutol

C.Pancreatic ascites; octreotide

D.Secondary bacterial peritonitis; piperacillin-tazobactam + source control

Explanation: Ascitic PMN >=250/mm^3 defines spontaneous bacterial peritonitis (SBP). Empiric therapy is a 3rd-gen cephalosporin (ceftriaxone 2 g IV daily or cefotaxime 2 g IV q8h) for 5 days. Add IV albumin 1.5 g/kg on day 1 and 1 g/kg on day 3 to reduce hepatorenal syndrome and mortality.

7What is the correct albumin dosing regimen in SBP to reduce risk of hepatorenal syndrome?

A.25 g IV once

B.1.5 g/kg on day 1 and 1 g/kg on day 3

C.2 g/kg single dose

D.Albumin is not indicated

Explanation: The Sort/Gines trial showed albumin 1.5 g/kg on day 1 plus 1 g/kg on day 3 reduces HRS incidence and mortality in SBP. Especially beneficial if bilirubin >4 or creatinine >1.

8Which antibiotic is used for SECONDARY prophylaxis after an SBP episode?

A.Amoxicillin

B.Ciprofloxacin or norfloxacin

C.Metronidazole

D.Doxycycline

Explanation: After SBP, secondary prophylaxis with daily fluoroquinolone (ciprofloxacin 500 mg PO daily or norfloxacin 400 mg daily) or TMP-SMX is recommended indefinitely until transplant or resolution of ascites. Reduces SBP recurrence from ~70% to ~20%.

9A patient with cirrhosis develops acute kidney injury with creatinine rising from 0.9 to 2.8 mg/dL over 10 days, no proteinuria, no response to albumin challenge 1 g/kg x 2 days, and bland urine sediment. Which is the most likely diagnosis?

A.Acute tubular necrosis

B.Hepatorenal syndrome type 1 (HRS-AKI)

C.Hepatorenal syndrome type 2

D.Glomerulonephritis

Explanation: HRS-AKI (formerly type 1) features rapid progression (<2 weeks), doubling of creatinine to >2.5 or stage 2+ AKI, absence of shock, no response to volume/albumin challenge, bland urine. Type 2 (now HRS-NAKI/CKD) is slower with refractory ascites.

10Which vasoconstrictor received FDA approval in 2022 for HRS-AKI based on the CONFIRM trial?

A.Midodrine

B.Norepinephrine

C.Terlipressin

D.Octreotide

Explanation: Terlipressin (Terlivaz) received FDA approval in September 2022 for HRS-AKI based on the CONFIRM trial. Dosing: 0.85 mg IV q6h plus albumin. Mechanism: V1 receptor agonist causing splanchnic vasoconstriction. Monitor for ischemic complications and respiratory failure; avoid in acute-on-chronic liver failure grade 3 or high baseline creatinine.

About the ABIM Tx Hepatology Exam

The ABIM Transplant Hepatology subspecialty exam certifies gastroenterologists who complete a 1-year ACGME-accredited Transplant Hepatology fellowship (or the combined 3-year GI/Transplant Hepatology pathway). It covers cirrhosis and portal hypertension, viral/alcohol/autoimmune/metabolic liver disease, MASH/MASLD (2023 nomenclature), HCC and hepatobiliary malignancies, liver transplantation candidacy, immunosuppression, rejection, and pre/post-transplant management including recurrence and opportunistic infection.

Questions

180 scored questions

Time Limit

~9-hour exam day (two sessions of ~4 hours)

Passing Score

Criterion-referenced scaled score (pass/fail; specific cut not published)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Tx Hepatology Exam Content Outline

25%

Cirrhosis and Portal Hypertension

Child-Pugh A/B/C, MELD-Na (higher = higher priority, 40 cap), decompensation events (variceal bleed, ascites, HE, SBP, jaundice). Variceal prophylaxis — NSBB (propranolol, nadolol, carvedilol) + EVL. SBP: ascitic PMN >=250, empiric ceftriaxone, albumin 1.5 g/kg day 1 + 1 g/kg day 3, secondary prophylaxis ciprofloxacin/norfloxacin. HRS type 1 (<2 wk) vs type 2 (slow) — albumin + terlipressin (2022 FDA CONFIRM). HE lactulose (3 BMs/day) + rifaximin. Rebalanced hemostasis, avoid FFP unless bleeding, thrombopoietin agonists (avatrombopag, lusutrombopag) for procedures (ADAPT, L-PLUS).

15%

Viral Hepatitis (HCV, HBV, HDV)

HCV pangenotypic DAAs — glecaprevir-pibrentasvir 8 wk (tx-naive, no cirrhosis or Child-Pugh A), sofosbuvir-velpatasvir 12 wk all genotypes. HBV — entecavir vs TDF vs TAF (renal/bone safety), HBeAg+ vs HBeAg- treatment thresholds, functional cure rare. HDV coinfection bulevirtide (Hepcludex 2023). Reactivation screening HBsAg + anti-HBc total pre-immunosuppression; DAA-associated HBV reactivation.

15%

Alcohol-Related, Autoimmune, and Cholestatic Liver Disease

AUDIT screening, AH Maddrey's DF >32 → prednisolone if no GIB/renal/infection; pentoxifylline no benefit (STOPAH). Early transplant for severe AH without mandatory 6-mo abstinence (Mathurin/STROKE). AUD pharm — naltrexone/acamprosate/baclofen. AIH type 1 (ANA/SMA) vs type 2 (LKM-1/LC-1), plasma cells + interface hepatitis, steroids + azathioprine induction, AZA monotherapy maintenance, MMF 2nd-line. PBC — AMA, UDCA 13-15 mg/kg 1st-line, OCA 2nd, elafibranor (Mar 2024 FDA) and seladelpar (Aug 2024 FDA). PSC — MRCP beading, UDCA >28 mg/kg harmful, CCA surveillance MRI+CA 19-9 q6-12mo, IBD association ~80%, dominant stricture ERCP.

10%

MASH/MASLD and Metabolic/Inherited Liver Disease

2023 NAFLD-to-MASLD Delphi renaming with cardiometabolic criteria (>=1: obesity/T2DM/dyslipidemia/HTN/CV). Resmetirom (Rezdiffra, FDA Mar 2024) — first-ever MASH approval for F2-F3, thyroid receptor-beta. Lifestyle + weight loss + GLP-1 (semaglutide). Statins safe. Hemochromatosis HFE C282Y homozygous — phlebotomy target ferritin 50-100, avoid vitamin C/iron. Wilson ATP7B — KF rings, low ceruloplasmin, high urinary Cu, high hepatic Cu — penicillamine + zinc, trientine 2nd-line. Alpha-1 AT Pi*ZZ, glycogen storage disease, porphyria.

15%

HCC and Other Liver Tumors

AASLD 2023 surveillance US +/- AFP q6mo (cirrhosis or HBV high-risk). LI-RADS 1-5 on CT/MRI. Milan criteria (1 lesion <=5 cm or 3 <=3 cm each); UCSF extended. Curative transplant or resection; locoregional TACE/TARE/ablation. Systemic 1L atezolizumab + bevacizumab (IMbrave150 2020), durvalumab + tremelimumab STRIDE (HIMALAYA 2022), lenvatinib, sorafenib; 2L regorafenib/cabozantinib/ramucirumab. Cholangiocarcinoma — ivosidenib (IDH1, 2021 FDA), pemigatinib/infigratinib (FGFR2 fusions). FNH, adenoma (OCP/pregnancy, rupture), hemangioma.

15%

Liver Transplantation: Candidacy and Perioperative

Indications — ALF King's College criteria, decompensated cirrhosis, HCC Milan (or downstaging). MELD exceptions for HCC. Combined liver-kidney — sustained eGFR <60. Induction (none/basiliximab/ATG); maintenance tacrolimus + MMF + early steroid withdrawal/taper; renal-sparing everolimus mTOR + lower CNI. Trough monitoring, CYP3A4 interactions (azoles, clarithromycin, amiodarone). Recurrence of disease — HCV DAA, HBV HBIG + NA, recurrent AIH/PBC/PSC.

Post-Transplant Rejection, Infection, and Long-Term Care

Cellular rejection — Banff T-cell-mediated vs antibody-mediated (DSA + C4d). Post-tx HCC surveillance 5 yrs. PTLD (EBV). CMV prophylaxis vs preemptive valganciclovir. Fungal prophylaxis. Infection timing — <1 mo nosocomial/opportunistic, 1-6 mo CMV/PCP/fungal, >6 mo community/novel. Skin cancer, PTLD, metabolic syndrome, CKD.

How to Pass the ABIM Tx Hepatology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail; specific cut not published)
Exam length: 180 questions
Time limit: ~9-hour exam day (two sessions of ~4 hours)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Tx Hepatology Study Tips from Top Performers

1Master MELD-Na and Child-Pugh cold — know that higher MELD-Na means higher waitlist priority (capped at 40), that MELD-Na exception points exist for HCC within Milan, and that simultaneous liver-kidney requires sustained eGFR <60 per OPTN 2017 policy. Memorize the Maddrey DF >32 and MELD >20 thresholds for steroids in alcohol-associated hepatitis.

2Know the 2023 MASLD renaming and the 2024 drug approvals cold: MASLD replaces NAFLD (Delphi consensus requires >=1 cardiometabolic criterion), resmetirom (Rezdiffra, thyroid receptor-beta) is FDA approved for non-cirrhotic F2-F3 MASH (March 2024), and elafibranor (June 2024) and seladelpar (August 2024) are new second-line PBC therapies alongside obeticholic acid. GLP-1s (semaglutide) are increasingly used adjunctively.

3For HCC, drill Milan (1 lesion <=5 cm or up to 3 lesions each <=3 cm) and UCSF criteria, the q6-month US +/- AFP surveillance strategy for cirrhosis and high-risk HBV, LI-RADS scoring, and first-line systemic therapy (atezolizumab + bevacizumab, IMbrave150) and second-line options (lenvatinib, cabozantinib, regorafenib, ramucirumab, durvalumab + tremelimumab STRIDE from HIMALAYA).

4Learn HCV DAA regimens by memory: glecaprevir-pibrentasvir 8 weeks for treatment-naive without cirrhosis or with Child-Pugh A cirrhosis, and sofosbuvir-velpatasvir 12 weeks pangenotypic. For HBV, know entecavir vs TDF vs TAF renal and bone considerations, HBeAg+ vs HBeAg- treatment thresholds, and always check HBsAg + anti-HBc total before immunosuppression or DAA therapy to prevent reactivation.

5Post-transplant: tacrolimus + MMF + steroid taper is standard maintenance, with renal-sparing everolimus as an mTOR-based CNI-reducing strategy. Know Banff rejection grading (T-cell-mediated) vs antibody-mediated rejection (DSA + C4d), CMV prophylaxis vs preemptive valganciclovir, and opportunistic infection timing (<1 month nosocomial/technical, 1-6 months CMV/PCP/fungal, >6 months community/novel pathogens). Recurrent disease is treated with DAAs (HCV), HBIG + NA (HBV), and immunosuppression adjustments for recurrent AIH/PBC/PSC.

Frequently Asked Questions

Who is eligible for the ABIM Transplant Hepatology exam?

Candidates must hold current ABIM certification in Gastroenterology and must have completed a 1-year ACGME-accredited Transplant Hepatology fellowship. Alternatively, candidates may complete the combined 3-year GI/Transplant Hepatology pathway that integrates transplant hepatology training into the final year of GI fellowship. A valid, unrestricted US medical license and program director verification of clinical competence are also required.

How often is the Transplant Hepatology exam offered and how is it structured?

ABIM typically administers the Transplant Hepatology exam every two years (biennially). It is a computer-based exam at Pearson VUE containing approximately 180 single-best-answer MCQs across two sessions of roughly four hours each, with an overall ~9-hour exam day including tutorial and breaks.

What does the Transplant Hepatology exam cost?

The ABIM application plus exam fee for Transplant Hepatology is approximately $2,990 in 2026. Late fees apply after the regular deadline. Check the current ABIM fee schedule, as fees change annually.

What is the pass rate for the ABIM Transplant Hepatology boards?

ABIM-reported first-time pass rates for Transplant Hepatology have historically been in the 85-95% range, reflecting the highly selected, fellowship-trained candidate pool. Pass rates for repeat takers are lower. See ABIM's annual pass-rate report for the most current data.

What topics are highest yield on the Transplant Hepatology boards?

Cirrhosis decompensation (variceal bleeding prophylaxis, SBP, HRS with terlipressin, HE), MELD-Na waitlist prioritization, HCV DAA regimens and HBV nucleosides, MASH/MASLD (including 2024 resmetirom), HCC staging with Milan/UCSF and systemic therapy (IMbrave150, HIMALAYA), and liver transplant immunosuppression, rejection, and recurrence. Know PBC second-line agents (OCA, elafibranor, seladelpar) and the 2023 MASLD nomenclature.

What references and resources are recommended for board prep?

AASLD Practice Guidelines (HCC 2023, cirrhosis ascites, HCV, HBV, PBC, PSC, alcohol-associated liver disease), the OPTN/UNOS liver allocation policy, and ISHLT-equivalent liver transplant consensus documents. High-yield textbooks include Sherlock's Diseases of the Liver and Biliary System and Zakim & Boyer's Hepatology. AASLD Transplant Hepatology Board Review courses are widely used, along with question banks with detailed rationales.

How do I maintain my Transplant Hepatology certification after passing?

ABIM offers continuous MOC via the Longitudinal Knowledge Assessment (LKA) — roughly 30 questions per quarter, open-book — or a traditional 10-year recertification exam. You must also keep your underlying Gastroenterology certification active and meet ABIM professional standing requirements.

Is Transplant Hepatology certification worth it career-wise?

Yes for gastroenterologists practicing at or aspiring to practice at liver transplant centers. UNOS-member transplant programs and CMS require formal transplant hepatology training for medical directorship roles, and board certification is increasingly expected for independent patient selection and listing decisions. Certified transplant hepatologists command a meaningful compensation premium over general gastroenterologists at academic and high-volume tertiary programs.