Requirements for candidacy:
The patient has a progressive, potentially fatal liver disorder or suffers from a complication directly related to a liver disorder which substantially impairs the quality of life and daily function, and for which all alternative medical and surgical treatments short of liver transplantation have been exhausted.
The patient’s liver disease is not expected to recur and cause disability within 5 years.
The patient is not moribund and the OLT is likely to prolong life for at least five years (better than 50% chance of five year survival), and the OLT will restore the patient to a range of physical and social function suitable for the activities of daily living.
The patient does not have involvement of a major system (eg. cardiovascular or neurologic) which would preclude surgery or indicate a poor potential for rehabilitation.
The patient’s psychological assessment, social arrangement, and family support indicate reasonable expectation that the patient will adhere strictly to the difficult long-term medical regimen which will be required post-transplant
The patient has no active alcohol or substance abuse problems and has signed a contract, has completed at least 6 months of documented rehabilitation and sobriety, and has psychological clearance
The patient has a diagnosis meeting criteria for OLT, severity of illness meeting minimum listing criteria and does not have any absolute contraindication.
The patient undergoes comprehensive assessment that is reviewed by the multidisciplinary transplantation committee.
Chronic liver failure:
Cholestatic disorders
Primary Biliary Cirrhosis
Biliary Atresia
Alagille’s syndrome
Familial cholestasis
Secondary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Parenchymal Cirrhosis
Cryptogenic Cirrhosis
Chronic Hepatitis B and C
Alcoholic Cirrhosis
Congenital hepatic fibrosis
Autoimmmune hepatitis
Drug induced
Toxins
Hypersensitivity
Fulminant hepatitis/necrosis
Metabolic Liver Diseases
Metabolic defect in the liver resulting in end-stage liver disease eg.
Alpha 1 antitrypsin deficiency
Wilson's disease
Hemochromatosis
Tyrosinemia
Protoporphyria
Cystic fibrosis
Metabolic defect in the liver, extrahepatic organs or systems primarily affected, eg.
Urea cycle defects
Familial hypercholesterolemia, type 2
Glycogen storage disease
Primary hyperoxaluria type 1
Crigler-Najjar syndrome type 1
Generalized metabolic disorders e.g.,
Cystic fibrosis
Neimann-Pick disease
Familial amyloidosis
Indications for Liver Transplantation (cont’d)
Malignancies
Hepatocellular carcinoma
No tumor greater than 5 cm
No more than 3 lesions
No extrahepatic disease
No thrombosis of a primary portal vein branch
Hepatoblastoma
Objective response to chemotherapy
Confined to the liver
No thrombosis of a primary portal vein branch
Hemangioendothelioma (confined to the liver)
Non-carcinoid neuro-endocrine tumors (confined to the liver)
Vascular Disease
Budd Chiari syndrome
Portal Vein Thrombosis
Giant Hepatic Hemangioma
Alcoholics in recovery and other prior substance abusers who have documented abstinence for a minimum of six months and have undergone a thorough multidisciplinary assessment (including social and psychiatric evaluation) may be considered for liver transplantation if they possess appropriate psychosocial support systems so that they can comply with lifelong immunosuppressive therapy and be expected to maintain permanent abstinence from all addictive substances.