Selection Factors and Contraindications for Liver Transplant
Patient Selection for Adult Liver Transplantation
- Accepted indications for liver transplantation
- Advanced chronic liver disease due to multiple causes
- Fulminant hepatic failure
- Inherited metabolic liver disease
- Indications for liver transplantation in selected patients
- Alcoholic liver disease
- Unresectable hepatic malignancy
- No alternative form of therapy
- No absolute contraindication to liver transplantation
- Willingness and ability to accept liver transplantation and comply with follow-up care
- Ability to provide for the cost of liver transplantation and postoperative care
Adult Liver Transplantation Indications
- Presence of irreversible liver disease and a life expectancy of less than 12 months with no effective medical or surgical alternatives to transplantation
- Chronic liver disease that has progressed to the point of significant interference with the patient's ability to work or with his/her quality of life
- Progression of liver disease that will predictably result in mortality exceeding that of transplantation (85% one-year patient survival and 70% five-year survival)
Manifestations of End-Stage Liver Disease
- Progressive jaundice
- Intractable ascites
- Spontaneous bacterial peritonitis
- Hepatorenal Syndrome
- Encephalopathy
- Variceal bleeding
- Intractable pruritus
- Chronic fatigue (such as resulting in loss of gainful employment)
- Bleeding diathesis or coagulopathy
Specific Biochemical and Clinical Indications for Liver Transplantation Cholestatic Liver Disease
- Serum albumin < 3.0 g/dL
- Intractable pruritus
- Progressive bone disease
- Recurrent bacterial cholangitis
Hepatocellular Liver Disease
- Serum albumin in < 3.0 g/d L
- Prothrombin time >3 seconds above control
Both Cholestatic and Hepatocellular Liver Disease
- Recurrent or severe hepatic encephalopathy
- Refractory ascites
- Spontaneous bacterial peritonitis
- Recurrent portal hypertensive bleeding
- Severe chronic fatigue and weakness
- Progressive malnutrition
- Development of hepatorenal syndrome
- Detection of small, coincidental hepatocellular carcinoma
Contraindications to Adult Liver Transplantation
- Extrahepatic malignancy
- Extrahepatic sepsis
- Advanced cardiopulmonary disease
- Active or recent (< 6 months) alcoholism or substance abuse
