AASLD PRACTICE GUIDELINES-Liver Transplant

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Vol. 6, Issue 1, pp. 122-135, January 2000

AASLD PRACTICE GUIDELINES

Liver Transplantation

L. Carithers, Jr

From the Division of Gastroenterology, University of Washington School of

Medicine, Seattle, WA.

Liver transplantation has revolutionized the care of patients with end-stage

liver disease. Liver transplantation is indicated for acute or chronic liver

failure from any cause. Because there are no randomized controlled trials of

liver transplantation versus no therapy, the efficacy of this surgery is

best assessed by carefully comparing postoperative survival with the known

natural history of the disease in question. The best examples of this are in

primary biliary cirrhosis and primary sclerosing cholangitis, for which

well-validated disease-specific models of natural history are available.

There are currently relatively few absolute contraindications to liver

transplantation. These include severe cardiopulmonary disease, uncontrolled

systemic infection, extrahepatic malignancy, severe psychiatric or

neurological disorders, and absence of a viable splanchnic venous inflow

system. One of the most frequently encountered contraindications to

transplantation is ongoing destructive behavior caused by drug and alcohol

addiction. The timing of the surgery can have a profound impact on the

mortality and morbidity of patients undergoing liver transplantation.

Because of the long waiting lists for donor organs, the need to project far

in advance when transplantation might be required has proven to be one of

the greatest challenges to those treating patients with end-stage liver

disease. Three important questions must be addressed in a patient being

considered for liver transplantation: (1) when should the patient be

referred for possible transplantation? (2) when should the patient be listed

for transplantation? and (3) when is the patient too sick to have a

reasonable chance of surviving the perioperative period?

Liver Transplantation, Vol 6, No 1 (January), 2000: pp 122-135

1527-6465/00/0601-0021$3.00/0

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