Liver transplantation

Abstract

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?

Long-term quality of life of liver transplant recipients beyond 60 years of age

“…Advances in surgical procedures and ameliorated immunosuppressive therapy have led to an extended patient and graft survival (Merion 2010;Wagner et al 2012). As a result, upper recipient age limits have been increased in the past years, and an older recipient age is not considered as a contraindication any more (Carithers 2000). In the early years of OLT, the upper age limit for recipients did not exceed 55 years (Shaw 1994).…”

Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

“…Advanced age is not considered an absolute contraindication for liver transplantation (LT) (1). In the early years of LT the upper limit of age for its indication was 45-55 years (2).…”

Liver transplantation for hereditary hemochromatosis

“…The recently published American Association for the Study of Liver Diseases Practice Guidelines on Liver Transplantation concluded that OLT was indicated in carefully selected patients with HHC, but that more research was needed to determine the optimum use of OLT in these patients. 70 Because HHC is an uncommon indication for OLT, it is unlikely that meaningful conclusions can be drawn from a single-center experience. Therefore, multicenter studies that use uniform diagnostic criteria with well-defined end points are critical to further our understanding of iron overload in the setting of OLT.…”