Abdallah MA, Kuo YF, Asrani S, et al. - Researchers intended to determine if there is an interaction between acute on chronic liver failure (ACLF) and MELD score in predicting waitlist (WL) mortality. Of 18,416 candidates who had ACLF at listing (mean age 54 years, 69% males, 63% Caucasians), 90-day WL mortality (patient death or being too sick for LT) was 21.6% (18%, 20%, 25%, and 39% for ACLF grades 1, 2, 3a, and 3b respectively). Among chosen participants who have ACLF at listing, MELD score and ACLF interact in anticipating the cumulative risk of 90-day WL mortality, with the higher impact of ACLF grade at lower listing MELD score. Validating such results in large prospective studies will support to factor in both MELD and ACLF in prioritizing transplant candidates and allocation of liver grafts.