Liver transplantation indications
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Indications
Acute liver failure
- Acute liver failure is defined by the development of severe acute liver injury with encephalopathy and impaired synthetic function.[1]
Cirrhosis
- Patients with cirrhosis are typically candidates for liver transplantation once their biologic Model for End-stage Liver Disease (MELD) score is ≥15.[2]
- Variceal hemorrhage, ascites, and encephalopathy are the primary manifestations of end-stage liver disease and are designated as markers of decompensation.
- Some patients with Child B cirrhosis with portal hypertension but a low MELD score may be candidates for liver transplantation.
- The transplantation evaluation is typically started once a patient has a MELD score >10.
- Patients may also qualify for liver transplantation if they have a complication or condition that qualifies for standard MELD exception points
- Hepatocellular carcinoma
- Hepatopulmonary syndrome
- Portopulmonary hypertension (provided the mean arterial pressure can be maintained at <35 mmHg with treatment)
- Familial amyloid polyneuropathy
- Primary hyperoxaluria
- Cystic fibrosis
Liver neoplasms
- Patients with some primary liver neoplasms may be candidates for liver transplantation, provided the neoplasms meet specific criteria (eg, for patients with hepatocellular carcinoma [HCC], a single lesion ≤5 cm or up to three separate lesions all <3 cm, no evidence of gross vascular invasion, and no regional nodal or distant metastases).
- Some of the liver neoplasms that have been treated with liver transplantation include:[3]
- HCC: For patients who are not candidates for resection and who have a single lesion ≤5 cm, no more than three separate lesions, none larger than 3 cm, no evidence of gross vascular invasion, and no regional nodal or distant metastases, we recommend liver transplantation (Grade 1B).[4]
- These criteria have become known as the Milan criteria.
- Considerable interest has arisen in expansion of these transplant criteria in highly specialized centers, although such expanded criteria remain purely investigational at present.
- Epithelioid hemangioendothelioma[5]
- Large hepatic adenomas
Metabolic disorders
Liver-based metabolic conditions that have been treated with liver transplantation include:[6][7][8]
- Familial amyloid polyneuropathy (qualifies for standard MELD exception points)
- Primary hyperoxaluria
- Cystic fibrosis
- Alpha-1 antitrypsin deficiency
- Some forms of glycogen storage disease
- Tyrosinemia: LT is performed in patients with persistent liver failure who do not respond to nitisinone therapy or have hepatic malignancy
- Hemochromatosis
- Wilson disease: For those with advanced liver disease, a prognostic scoring system for children with Wilson disease presenting with failure was proposed by a group at Kings College and then later revised [87,88].
- Acute intermittent porphyria
- ↑ Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH; et al. (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann Intern Med. 137 (12): 947–54. PMID 12484709.
- ↑ Martin P, DiMartini A, Feng S, Brown R, Fallon M (2014). "Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation". Hepatology. 59 (3): 1144–65. PMID 24716201.
- ↑ Eghtesad B, Aucejo F (2014). "Liver transplantation for malignancies". J Gastrointest Cancer. 45 (3): 353–62. doi:10.1007/s12029-014-9590-2. PMID 24604263.
- ↑ Longeville JH, de la Hall P, Dolan P, Holt AW, Lillie PE, Williams JA; et al. (1997). "Treatment of a giant haemangioma of the liver with Kasabach-Merritt syndrome by orthotopic liver transplant a case report". HPB Surg. 10 (3): 159–62. PMC 2423854. PMID 9174860.
- ↑ Tepetes K, Selby R, Webb M, Madariaga JR, Iwatsuki S, Starzl TE (1995). "Orthotopic liver transplantation for benign hepatic neoplasms". Arch Surg. 130 (2): 153–6. PMID 7848084.
- ↑ Carey EJ, Iyer VN, Nelson DR, Nguyen JH, Krowka MJ (2013). "Outcomes for recipients of liver transplantation for alpha-1-antitrypsin deficiency–related cirrhosis". Liver Transpl. 19 (12): 1370–6. doi:10.1002/lt.23744. PMID 24019185.
- ↑ Kowdley KV, Brandhagen DJ, Gish RG, Bass NM, Weinstein J, Schilsky ML; et al. (2005). "Survival after liver transplantation in patients with hepatic iron overload: the national hemochromatosis transplant registry". Gastroenterology. 129 (2): 494–503. doi:10.1016/j.gastro.2005.05.004. PMID 16083706.
- ↑ Tsuchiya A, Yazaki M, Kametani F, Takei Y, Ikeda S (2008). "Marked regression of abdominal fat amyloid in patients with familial amyloid polyneuropathy during long-term follow-up after liver transplantation". Liver Transpl. 14 (4): 563–70. doi:10.1002/lt.21395. PMID 18383093.