Liver transplantation in adults: Patient selection and pretransplantation evaluation
- Lorna M Dove, MD, MPH
Lorna M Dove, MD, MPH
- Assistant Professor, Department of Medicine
- Columbia University
- Robert S Brown, Jr, MD, MPH
Robert S Brown, Jr, MD, MPH
- Section Editor — Liver Transplantation
- Vice Chair, Transitions of Care, Department of Medicine
- Interim Chief, Division of Gastroenterology and Hepatology
- Weill Cornell Medical College
- Professor of Clinical Medicine, Columbia University College of Physicians & Surgeons
Liver transplantation is an important treatment option for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy, though it is not the initial or primary treatment modality for most liver diseases.
Transplantation infrequently cures the underlying disease; recurrent liver disease after transplantation occurs in 0 to 100 percent of patients, depending on the disease for which transplantation was performed. Thus, the decision to list a patient for transplantation is a risk-benefit analysis in which the inherent risks of surgery, recurrent disease, and long-term immunosuppression must be weighed against the potential benefits of transplantation. These benefits differ for each patient but include improvements in survival, prevention of long-term complications, and better health-related quality of life. In most cases, the risks associated with recurrent disease do not outweigh the benefits of liver transplantation.
This topic will review the selection of patients for liver transplantation and the pretransplantation evaluation. Other issues related to liver transplantation including donor selection, living donor liver transplantation, ethical issues in liver transplantation, immunosuppression following liver transplantation, and the medical management of patients who have undergone liver transplantation are discussed elsewhere. (See "Liver transplantation: Donor selection" and "Living donor liver transplantation" and "Ethical issues in liver transplantation" and "Liver transplantation in adults: Overview of immunosuppression" and "Liver transplantation in adults: Long-term management of transplant recipients".)
In 2013, the American Association for the Study of Liver Diseases and the American Society of Transplantation developed guidelines regarding the indications for liver transplantation and the evaluation of patients being considered for liver transplantation . The discussion that follows is generally consistent with those guidelines.
Indications for liver transplantation include acute liver failure, cirrhosis with complications, some liver neoplasms, and liver-based metabolic conditions with systemic manifestations [1,2].
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- Acute liver failure
- Liver neoplasms
- Metabolic disorders
- PRETRANSPLANTATION EVALUATION
- Laboratory testing
- Cardiopulmonary evaluation
- - Electrocardiogram
- - Cardiac stress testing
- - Echocardiography
- - Pulse oximetry
- - Additional testing for pulmonary disease
- Cancer screening
- Infectious disease evaluation and vaccinations
- Hepatic imaging and HCC staging
- Upper endoscopy
- Bone density testing
- Psychosocial evaluation and education
- ADULT LIVING DONOR LIVER TRANSPLANTATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS