Who Do I Refer for Liver Transplantation in 2018?

Abstract

Liver transplantation (LT) remains a life-saving and curative procedure for those with complications of cirrhosis, including decompensation and hepatocellular carcinoma (HCC). Other indications include congenital, metabolic, and vascular diseases, and acute/fulminant liver failure. Although the indication for LT has been well established for a long time, there have been recent changes in the disease spectrum being transplanted, likely due to the effects of highly effective antiviral therapy for chronic hepatitis B/C. Various different criteria exist to determine the eligibility for LT for different conditions, such as that for acute liver failure and HCC. Although the underlying liver condition may be an indication for LT, not all patients are suitable, and there are a number of absolute and relative contraindications which must be considered. Some of these may be correctable, and therefore should be discussed with the LT center if in doubt. Assessment of potential LT recipient (and donors) is intensive; therefore timely referral to a LT center is essential.