Indications and Contraindications for Liver Transplantation

Varma, Vibha; Mehta, Naimish; Kumaran, Vinay; Nundy, Samiran

doi:10.4061/2011/121862

Cited by 64 publications

(54 citation statements)

References 41 publications

(43 reference statements)

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“…This behavior denotes a highrisk group requiring psychiatric assessment and treatment. Active drug abuse is a relative contraindication to be listed for LT [28]. Such patients tend to be poorly compliant with post-transplantation care and follow-up, and thus have worse outcomes.…”

Section: Evaluation Of Candidates For Liver Transplantationmentioning

confidence: 99%

End‐stage liver failure: liver transplant evaluation

Marciano

Gadano

2015

Cirrhosis: A Practical Guide to Management

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Section: Evaluation Of Candidates For Liver Transplantationmentioning

confidence: 99%

End‐stage liver failure: liver transplant evaluation

Marciano

Gadano

2015

Cirrhosis: A Practical Guide to Management

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“…En nuestro país, sus indicaciones han sido recientemente consensuadas y sus resultados son comparables a los de grandes centros internacionales 5 . Con los avances en la técnica quirúrgica y los cuidados postoperatorios, las contraindicaciones para el trasplante hepático han disminuido 6,7 . La trombosis venosa portal (TP), considerada tradicionalmente una contraindicación para el trasplante 8 , es hoy aceptada como un factor más de riesgo de complicaciones intra y postoperatorias, pero susceptible de ser tratada previo o durante el trasplante.…”

Section: Trasplante Hepático En Pacientes Con Trombosis De La Vena Pounclassified

Trasplante hepático en pacientes con trombosis de la vena porta

et al. 2013

Rev Chil Cir

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Liver transplantation in patients with portal vein thrombosisPortal vein thrombosis (PVT) is a serious complication of end-stage liver disease, representing a challenge for the liver transplantation (LT) team. The aim of this study was to analyze the results of LT in patients with PVT. Methods: All adult patients who underwent a LT from a cadaveric donor between March 1994 and March 2010 were included. PVT was categorized using the classification of Yerdel and McMaster. Results: A total of 109 LT were performed in 105 patients. PVT was found in 13 cases (12.4%). In 6 of them (46.2%), thrombosis was found preoperatively by transplant routine work up. Pre-transplant systemic anticoagulation was indicated in 3 cases. At the time of surgery, only 10 patients had persistent PVT. Grade I, II, III and IV PVT was found on 2, 3, 4 and 1 patient respectively. In the 3 cases treated with systemic anticoagulation preoperatively, grade I (1 case) and grade II (2 cases) no thrombus was evident intraoperatively. Endovenectomy was performed in 7 cases; simple thrombectomy in one and a mesenteric vein graft was required in 2 cases. No thrombus recurrence was detected on postoperative follow-up. In-hospital mortality occurred in 2 cases with PTV grade III and IV due to medical complications. One-year patient and graft survival was 69% vs 79% in patients without PVT (p = 0,476). Conclusion: Liver transplant in patients with PVT thrombosis was not associated with a significant increased risk of mortality. Systemic anticoagulation seems to be warranted while waiting for liver transplantation.Key words: Liver transplantation, portal vein thrombosis. ResumenLa trombosis de la vena porta (TP) es una complicación grave de la enfermedad hepática crónica terminal. La factibilidad y pronóstico del trasplante hepático (TH) dependen de su extensión en el eje portoRev.

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“…The current established absolute contraindications for LT include advanced cardiopulmonary disease, extrahepatic malignancy with metastasis, active substance abuse, sepsis, and inability to comply with medical treatment [10] . Despite multiple efforts, there is currently no agreed upon definition of "too sick to transplant", nor there are standardized guidelines for when a critically ill patient should be removed from a transplant waiting list [11,12] .…”

Section: Introductionmentioning

confidence: 99%

Outcomes following liver transplantation in intensive care unit patients

Sibulesky

Heckman

Taner

et al. 2013

WJH

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AIM:To determine feasibility of liver transplantation in patients from the intensive care unit (ICU) by estimating graft and patient survival. METHODS:This single center retrospective study included 39 patients who had their first liver transplant directly from the intensive care unit and 927 non-ICU patients who were transplanted from hospital ward or home between January 2005 and December 2010. RESULTS:In comparison to non-ICU patients, ICU patients had a higher model for end-stage liver disease (MELD) at transplant (median: 37 vs 20, P < 0.001).Fourteen out of 39 patients (36%) required vasopressor support immediately prior to liver transplantation (LT) with 6 patients (15%) requiring both vasopressin and norepinephrine. Sixteen ICU patients (41%) were ventilator dependent immediately prior to LT with 9 patients undergoing percutaneous tracheostomy prior to transplantation. Twenty-five ICU patients (64%) required dialysis preoperatively. At 1, 3 and 5 years after LT, graft survival was 76%, 68% and 62% in ICU patients vs 90%, 81% and 75% in non-ICU patients.Patient survival at 1, 3 and 5 years after LT was 78%, 70% and 65% in ICU patients vs 94%, 85% and 79% in non-ICU patients. When formally comparing graft survival and patient survival between ICU and non-ICU patients using Cox proportional hazards regression models, both graft survival [relative risk (RR): 1.94, 95%CI: 1.09-3.48, P = 0.026] and patient survival (RR: 2.32, 95%CI: 1.26-4.27, P = 0.007) were lower in ICU patients vs non-ICU patients in single variable analysis.These findings were consistent in multivariable analysis. Although not statistically significant, graft survival was worse in both patients with cryptogenic cirrhosis (RR: 3.29, P = 0.056) and patients who received donor after cardiac death (DCD) grafts (RR: 3.38, P = 0.060).These findings reached statistical significance when considering patient survival, which was worse for patients with cryptogenic cirrhosis (RR: 3.97, P = 0.031) and patients who were transplanted with DCD livers (RR:4.19, P = 0.033). Graft survival and patient survival were not significantly worse for patients on mechanical ventilation (RR: 0.91, P = 0.88 in graft loss; RR: 0.69, P = 0.56 in death) or patients on vasopressors (RR: 1.06, P = 0.93 in graft loss; RR: 1.24, P = 0.74 in death) immediately prior to LT. Trends toward lower graft survival and patient survival were observed for patients on 26January 27, 2013|Volume 5|Issue 1|

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Indications and Contraindications for Liver Transplantation

Cited by 64 publications

References 41 publications

End‐stage liver failure: liver transplant evaluation

End‐stage liver failure: liver transplant evaluation

Trasplante hepático en pacientes con trombosis de la vena porta

Outcomes following liver transplantation in intensive care unit patients

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