Patients with end stage liver disease that has failed standard medical and surgical therapy can be considered for liver transplantation. Signs and symptoms of end stage liver disease include jaundice, ascites, edema, variceal bleeding, low platelet count, fatigue, severe itching and worsening mental confusion. A number of acute and chronic diseases of the liver can result in end stage liver disease. Appropriate patient selection is paramount to the overall success of liver transplantation.
Due to limited availability of donor livers, the procedure is contraindicated for patients who are unlikely to survive the procedure or receive long-term benefit. Patients are considered individually and their candidacy is assessed by a formal multidisciplinary evaluation process.
Common Indications for Liver Transplantation
- Cholestatic Disease: Primary biliary cirrhosis, sclerosing cholangitis, secondary biliary cirrhosis, biliary atresia, cystic fibrosis.
- Chronic Hepatitis: Hepatitis B, hepatitis C, Hepatitis D, autoimmune chronic active hepatitis, cryptogenic cirrhosis, chronic drug toxicity or toxin exposure.
- Laennec’s Cirrhosis: Patients with alcoholic cirrhosis are considered for transplant if they meet current criteria for abstinence and rehabilitation:
- Abstinence of alcohol for six months and routine surveillance blood testing
- Ongoing participation in formal alcohol treatment program
- Presence of adequate psychosocial supports as determined by social service and psychiatry consultants
- Patients who do not meet the above criteria at the time of referral will be given the opportunity to fulfill these criteria and undergo re-evaluation. Formal input from the psychiatry staff is required to assess the risk of return to alcohol use following liver transplantation.
- Metabolic Diseases: Hemochromatosis, Wilson’s disease, Alpha-1-antitrypsin deficiency, glycogen storage disease, tyrosinemia, familial amyloidotic polyneuropathy, and other metabolic disorders treatable by liver replacement.
- Fulminant Acute Hepatic Necrosis: Viral hepatitis, drug toxicity, toxin, and Wilson’s disease.
- Primary Hepatic Tumors: Selected patients with hepatocellular carcinoma.
- Failed Prior Transplant
- Idiopathic autoimmune liver disease
- Cryptogenic Cirrhosis
Contraindications for Liver Transplantation
While each patient is evaluated on an individual basis, the presence of one or more of the following will frequently preclude acceptance as a candidate for liver transplantation.
- Active alcohol or substance abuse
- Systemic infections
- Life limiting co-existing medical conditions: Advanced heart, lung or neurologic conditions
- Uncontrolled psychiatric disorder, psychiatric disorders that impair the patient's ability to give informed consent and be compliant
- Inability to comply with pre- and post-transplant regimens
- Uncontrolled bacterial or fungal infections outside the hepatobiliary system
- Active malignancy outside the hepatobiliary system, with the exception of neuroendocrine tumors
- Multiple uncorrected congenital anomalies
- Advanced and uncorrectable cardiopulmonary disease
- Active noncompliance
- Hepatocellular carcinoma greater than 5 cm.
- HIV positive
- Portal vein and Superior mesenteric vein thrombosis