Selection for Liver Transplantation: Indications and Evaluation
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MANAGEMENT OF THE CIRRHOTIC PATIENT (A CARDENAS AND P TANDON, SECTION EDITORS)
Selection for Liver Transplantation: Indications and Evaluation Nadim Mahmud 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Liver transplantation is an important therapeutic option for patients with life-limiting liver disease, which may present in the form of acute liver failure, end-stage chronic liver disease, primary hepatic cancers, or inborn metabolic disorders. While significant strides have been made with respect to liver transplantation outcomes, the practice is constrained by an organ supply/demand mismatch. The purpose of this review, therefore, is to review the general indications and contraindication to liver transplantation, and to provide an overview of the transplant evaluation process. These considerations ultimately shape the specific criteria for patient selection, which will continue to evolve as means are developed to expand the donor pool, improve surgical techniques, broaden indications for safe transplant, and extend the lifetime of a graft. Recent Findings Selected patients with unresectable hilar cholangiocarcinoma may be candidates for liver transplantation. Patients over 65 years may be transplant candidates if they possess a favorable comorbidity profile. Patients at body mass index extremes (≥ 40 or < 18.5) have increased post-transplant mortality and require nutritional evaluation. Summary Liver transplantation may be life saving for patients with acute liver failure or end-stage liver disease. It is therefore critical for healthcare providers caring for patients with liver disease to be familiar with the general indications for transplantation and to know when it is appropriate or inappropriate to refer for transplant evaluation. Keywords Liver transplantation . Cirrhosis . Acute liver failure . Model for end-stage liver disease (MELD) . Hepatocellular carcinoma . Cholangiocarcinoma
Introduction Liver transplantation (LT) may be curative or life prolonging for appropriately selected patients with acute liver failure, advanced cirrhosis, hepatic malignancy, or inborn metabolic disorders. Given vast improvements in surgical technique, organ preservation and procurement, and immunosuppression over the past several decades, modern LT is characterized by remarkable improvements in post-transplant patient survival, graft survival, and quality of life. In 2010, Duffy et al. demonstrated an actuarial 20-year post-transplant survival of 52% for the patient and 42% for the graft. They also reported
This article is part of the Topical Collection on Management of the Cirrhotic Patient * Nadim Mahmud [email protected] 1
Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
improved health-related quality of life in 20-year survivors as compared with control patients with chronic liver disease, diabetes, or congestive heart failure [1]. Taken together, LT is now regarded to be a durable surgery and is the thera
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