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Liver transplantation in adults: Patient selection and pretransplantation evaluation

Lorna M Dove, MD, MPH
Robert S Brown, Jr, MD, MPH
Section Editor
Keith D Lindor, MD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


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 [1]. The discussion that follows is generally consistent with those guidelines.


According to the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry, hepatocellular carcinoma and hepatitis C virus cirrhosis are the most common diseases leading to liver transplantation, although increasing numbers of patients with alcoholic cirrhosis and nonalcoholic steatohepatitis are receiving transplants [2]. For additional information, see optn.transplant.hrsa.gov/data/view-data-reports.

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Literature review current through: Nov 2017. | This topic last updated: Jun 29, 2017.
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