Pre-Liver Transplantation Evaluation and Listing

2019 ◽  
Vol 03 (04) ◽  
pp. 255-262
Author(s):  
Alexander Pan ◽  
Sean Koppe
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Comprehensive Evaluation ◽  
Organ Distribution ◽  
Post Transplantation ◽  
Term Survival ◽  
Transplant Candidates ◽  
Liver Transplant Waiting List ◽  
End Stage ◽  
Survival Risk

AbstractLiver transplantation provides a curative treatment option for patients with both acute and chronic liver disease, but the decision to list a patient for transplant should be an informed one to maximize post-transplantation benefit and survivability. Potential candidates meeting transplantation indications must undergo a comprehensive evaluation consisting of both physical, as well as psychiatric, assessment to be considered for transplantation. Once listed, a candidate's place on the liver transplant waiting list is determined predominantly by his or her Model for End-Stage Liver Disease (MELD)-Na score, which is a reliable tool to stratify short-term survival risk. The severity of certain conditions, however, is not accurately reflected by the MELD-Na score, and these particular diagnoses may be assigned MELD exception points. Herein, we discuss common indications for liver transplantation: the MELD system and its exceptions, the physical and psychosocial evaluation of potential transplant candidates, and some limitations of the current organ allocation system and efforts to reduce disparity in organ distribution.

Liver Transplantation for the Gastroenterologist

2015 ◽  
Author(s):  
Andreea M. Catana ◽  
Michael P. Curry
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Organ Procurement ◽  
The United States ◽  
Waiting Lists ◽  
Liver Graft ◽  
Term Survival ◽  
End Stage Liver Disease ◽  
End Stage

The first liver transplantation (LT) was performed in 1963, and currently more than 65,000 people in the United States are living with a transplanted liver. In 2012, the number of adults who registered on the LT waiting list decreased for the first time since 2002; 10,143 candidates were added compared with 10,359 in 2011. LT offers long-term survival for complications of end-stage liver disease and prolongs life in properly selected patients, but problems such as donor deficit, geographic disparities, and long waiting lists remain. This overview of LT for the gastroenterologist details the indications for LT and patient selection, evaluation, liver organ allocation, prioritization for transplantation, transplantation benefit by the Model for End-Stage Liver Disease (MELD), MELD limitations, sources of liver graft, strategies employed to decrease the donor deficit, complications, and outcomes. Figures include indications for LT in Europe and the United States, Organ Procurement and Transplantation Network regions in the United States, the number of transplants and size of active waiting lists, mortality by MELD, regional disparity, patient survival rates with and without hepatitis C virus, and unadjusted patient and graft survival. Tables list LT milestones, indications for LT, contraindications for LT, minimal listing criteria for LT, criteria for LT in acute liver failure, LT evaluation process, adult recipient listing status 1A, and early posttransplantation complications. This review contains 7 highly rendered figures, 8 tables, and 46 references. 

Hematologic Recovery After Liver Transplantation

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1734-1734
Author(s):  
Christopher Seidler ◽  
Adel Bozorgzadeh ◽  
Cheryl Ferrante-Hersperger ◽  
Zeina Al-Mansour ◽  
Mridula George ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Orthotopic Liver Transplantation ◽  
Conflicts Of Interest ◽  
Test Method ◽  
Post Transplantation ◽  
Advanced Liver Disease ◽  
End Stage Liver Disease ◽  
Co Morbidity ◽  
End Stage

Abstract Introduction Chronic liver disease is a national problem with over 3 million American suffering from end stage liver disease. The majority of patients with advanced liver disease have pancytopenia due to multiple factors. Hematology consults generated by the hematologic effects of end stage liver disease comprise 10-20% of consults. The majority of patients undergoing orthotopic liver transplantation achieve some degree of partial or complete hematologic recovery. Methods 196 sequential records for patients undergoing orthotopic liver transplantation were analyzed. Complete data was available for 92 patients. Hematologic parameters were reviewed 1 month prior to transplantation, 1 month post, 1 year and 2 year post transplantation. A statistical analysis was performed using the two tailed t-test method. Results Rapid and sustained hematologic recovery occurred in the majority of patients and was significant except for WBC at 24 months. Conclusions Orthotopic liver transplantation results in rapid sustained hematologic response in the majority of patients. Rapid recovery of platelet counts was most significant and does not reflect Ssplenectomy. Co-morbidity and anti-rejection drugs also may lead to delayed marrow suppression. Further sub-set analysis and measure of additional factors will also be presented. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Progress of the liver transplantation programme in Hungary

2013 ◽  
Vol 154 (22) ◽  
pp. 858-862 ◽  
Author(s):  
László Kóbori ◽  
Dénes Görög ◽  
Imre Fehérvári ◽  
Balázs Nemes ◽  
János Fazakas ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Wide Spectrum ◽  
The United States ◽  
Daily Routine ◽  
Cholestatic Liver Disease ◽  
Term Survival ◽  
End Stage Liver Disease ◽  
Number Of Patients ◽  
End Stage

The history of organ transplantation in Hungary dates back to 50 years, and the first succesful liver transplantation was performed in the United States in that time as well. The number of patients with end stage liver disease increased worldwide, and over 7000 patients die in each year due to liver disease in Hungary. The most effective treatment of end-stage liver disease is liver transplantation. The indications of liver transplantation represent a wide spectrum including viral, alcoholic or other parenchymal liver cirrhosis, but cholestatic liver disease and acute fulminant cases are also present in the daily routine. In pediatric patients biliary atresia and different forms of metabolic liver disorders represent the main indication for liver transplantation. The results of liver transplantation in Hungary are optimal with over 80% long-term survival. For better survival individual drug therapy and monitoring are introduced in liver transplant candidates. Orv. Hetil., 2013, 154, 858–862.

scholarly journals Liver Transplantation for Hepatitis C and Alcoholic Liver Disease

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Marco Carbone ◽  
James Neuberger
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hepatitis C ◽  
Alcohol Intake ◽  
Medium Term ◽  
History Of ◽  
Transplant Candidates ◽  
Few Data ◽  
End Stage

End-stage liver disease due to hepatitis C (HCV) and cirrhosis from alcohol (ALD) are the commonest indications for liver transplantation in the western countries. Up to one third of HCV-infected transplant candidates have a history of significant alcohol intake prior to transplantation. However, there are few data available about the possible interaction between alcohol and HCV in the post-transplant setting. Patients with both HCV and alcohol are more likely to die on the waiting list than those with ALD and HCV alone. However, after transplantation, non-risk adjusted graft and patient survival of patients with HCV + ALD are comparable to those of patients with HCV cirrhosis or ALD cirrhosis alone. In the short and medium term HCV recurrence after transplant in patients with HCV + ALD cirrhosis does not seem more aggressive than that in patients with HCV cirrhosis alone. A relapse in alcohol consumption in patients with HCV + ALD cirrhosis does not have a major impact on graft survival. The evidence shows that, as is currently practiced, HCV + ALD as an appropriate indication for liver transplantation. However, these data are based on retrospective analyses with relatively short follow-up so the conclusions must be treated with caution.

Low psoas muscle index as an unfavorable factor in children with end‐stage liver disease undergoing liver transplantation

2021 ◽  
Author(s):  
Settapong Jitwongwai ◽  
Chatmanee Lertudomphonwanit ◽  
Thitiporn Junhasavasdikul ◽  
Praman Fuangfa ◽  
Pornthep Tanpowpong ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Psoas Muscle ◽  
End Stage Liver Disease ◽  
End Stage
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