Indications and Contraindications for Liver Transplantation

Indications for liver transplantation

1- Acute liver failure

Acute hepatitis A
Acute hepatitis B
Drug/toxin hepatotoxicity

2- Cirrhosis from chronic liver diseases

Chronic hepatitis B virus and chronic hepatitis C virus infection
Alcoholic liver disease
Autoimmune hepatitis
Cryptogenic liver disease
Primary biliary cirrhosis and primary sclerosing cholangitis
Secondary biliary cirrhosis

3- Metabolic disorders

Alpha-1 antitrypsin deficiency
Hereditary hemochromatosis
Wilson’s disease
Glycogen-storage disorders
Type 1 hyperoxaluria
Familial homozygous hypercholesterolemia

4- Malignancy

Primary hepatic cancer: hepatocellular carcinoma and cholangiocarcinoma
Metastatic: carcinoid tumors and islet cell tumors

5- Miscellaneous

Polycystic liver disease
Budd-Chiari syndrome

Contraindications to liver transplantation

1- Absolute contraindications

Brain death
Extrahepatic malignancy
Active uncontrolled infection
Active alcoholism and substance abuse
AIDS
Severe cardiopulmonary disease
Uncontrolled sepsis
Inability to comply with medical regimen
Lack of psychosocial support
Anatomic abnormalities precluding liver transplantation
Compensated cirrhosis without complications (Child-Turcotte-Pugh score, 5–6)

2- Relative contraindications

Advanced age
Cholangiocarcinoma^a
HIV infection^a
Portal vein thrombosis
Psychologic instability

^a Transplantation for cholangiocarcinoma is undergoing study using protocols with strict selection criteria and use of chemotherapy and radiation. Transplantation for HIV infection without AIDS also is undergoing study as part of a National Institutes of Health protocol

References:

Yu AS, Keeffe EB. Liver transplantation. In: Zakim D, Boyer TD, editors. Hepatology: a textbook of liver disease. 4th edition. Philadelphia: Elsevier; 2003. p. 1617–56.
Ahmed A, Keeffe EB. Current indications and contraindications for liver transplantation. Clin Liver Dis. 2007 May;11(2):227-47. [Medline]