Indications for Liver Transplantation
General Indications:

Presence of end-stage liver disease with objective evidence of advanced physical
incapacitation or failure to thrive causing deterioration of the quality of life to an
unacceptable level due to documented, isolated liver disease.

A limited life expectancy, estimated at less than one year or transplantation that
dramatically improves outcome before congenital or metabolic diseases progress to
irreversible damage.

Unanimous agreement that previous medical therapy has been optimal and that no
surgical procedure other than transplantation offers realistic expectation of functional
improvement and extension of life

Expected compliance with medical regimens

Adequate psychosocial support system to aid the patient prior to and during the surgery
and to promote adherence to required post-transplant treatment regimens

Acceptable surgical risk
Specific Indications:

Malnutrition with progressive protein-calorie deficiency.

Uncorrectable coagulopathy (INR>1.5), Fibrinogen <150 mg/dl)

Recurrent hepatic encephalopathy

Refractory ascites

Spontaneous bacterial peritonitis

Development of the hepatorenal syndrome

Development of hepatopulmonary syndrome

Development of fulminant hepatic failure

Refractory, life-threatening variceal hemorrhage

Severe progressive metabolic bone disease, especially with spontaneous fractures
Reviewed 10/4/2010

Debilitating pruritus

Recurrent episodes of biliary sepsis

Unresectable primary hepatic malignancy confined to the liver

In-born errors of metabolism

Delayed cognition and physical development secondary to chronic liver disease
Contraindications to Liver Transplantation
The following deleterious factors negatively influence the outcome of liver transplantation and
therefore constitute contraindications to surgery.
Absolute Contraindications:

Extrahepatic malignancy

Uncontrollable systemic sepsis or viral infections

Active alcoholism or drug abuse in the presence of chronic liver disease. The patient
must have 6 months of documented abstinence in the presence of chronic liver disease. In
the Acute Liver failure patients, obtain psychiatry consultation for assessment of the
family support structure and likelihood of recidivism.

Irreversible advanced cardiac, pulmonary or other organ disease

Acquired immunodeficiency syndrome (AIDS)

Irreversible Multisystem Organ Failure

Uncorrectable congenital anomalies
Relative Contraindications:

History of behavior pattern or psychiatric illness considered likely to interfere
significantly with compliance

Inability to obtain adequate social support system

HIV positive state

Previous malignancy (there must be a disease-free interval of (2) two to five (5) years.
Reviewed 10/4/2010

Obesity
Reviewed 10/4/2010