Selection of patients for liver transplantation

Abstract

Liver transplantation is now available world-wide. It plays an important role in the treatment of irreversible acute and chronic liver disease (CLD). Selection of patients for liver transplantation is subject to many factors including economic, cultural, availability of donor organs and degree of illness. This article looks at seven general considerations for recipients of liver transplantation. As well, disease-specific criteria are investigated and include such areas as cirrhosis due to chronic hepatitis B virus (HBV), hepatitis C virus (HCV) positive cirrhosis, fulminant hepatic failure (FHF), malignancy, alcoholic liver disease (ALD), metabolic conditions and Budd-Chiari syndrome. If hepatic transplantation survival rates were to approach 95%, the relative risk ratio between transplantation and conservative therapy would increase. At present an 80% 1-5 year survival rate following transplantation should be expected.

The case for liver transplantation in end‐stage alcoholic liver disease

“…Alcohol-related liver disease is the most common form of severe liver disease in many nations and Australia is no exception [4,[6][7][8][9]. Although alcohol consumption in Australia has plateaued and even fallen in the past decade [9], alcoholic liver disease will continue to be a major problem for a considerable period to come.…”

“…Although alcohol consumption in Australia has plateaued and even fallen in the past decade [9], alcoholic liver disease will continue to be a major problem for a considerable period to come. Data from a number of liver transplant units have documented a change in referral patterns in the past decade [4,10]. These patients with advanced liver disease will present to the health system for treatment and adequate responses need to be defined.…”

“…Equally, it must be stressed that abstinence can lead to marked improvement in liver function thus avoiding a need for surgery [4]. Equally, it must be stressed that abstinence can lead to marked improvement in liver function thus avoiding a need for surgery [4].…”

“…Superficial examination of liver transplantation costs has led many to conclude that this is an expensive treatment option. From the outset of transplantation for liver disease, a number of disorders have been regarded as relative or absolute contraindications to the procedure [4,6]. Drug costs in subsequent years are estimated at $10 000 to $20 000.…”

“…Liver transplantation has become a routine treatment for end-stage liver disease [1][2][3]. New surgical techniques now ensure that the operation can be undertaken in children and in adults with complications that previously would have denied them access to the procedure [4]. Superficial examination of liver transplantation costs has led many to conclude that this is an expensive treatment option.…”