Liver transplantation indications: Difference between revisions
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{{CMG}}; {{AE}} {{MAD}} | {{CMG}}; {{AE}} {{MAD}} | ||
{{liver transplantation}} | {{liver transplantation}} | ||
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=== Cirrhosis === | === Cirrhosis === | ||
* Patients with cirrhosis are typically candidates for liver transplantation once their biologic Model for End-stage Liver Disease (MELD) score is ≥15.<ref name="pmid24716201">{{cite journal| author=Martin P, DiMartini A, Feng S, Brown R, Fallon M| title=Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. | journal=Hepatology | year= 2014 | volume= 59 | issue= 3 | pages= 1144-65 | pmid=24716201 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24716201 }}</ref> | * Patients with cirrhosis are typically candidates for liver transplantation once their biologic [[Model for End-Stage Liver Disease|Model for End-stage Liver Disease]] ([[MELD Score|MELD]]) score is ≥15.<ref name="pmid24716201">{{cite journal| author=Martin P, DiMartini A, Feng S, Brown R, Fallon M| title=Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. | journal=Hepatology | year= 2014 | volume= 59 | issue= 3 | pages= 1144-65 | pmid=24716201 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24716201 }}</ref> | ||
* Variceal hemorrhage, ascites, and encephalopathy are the | * Variceal [[hemorrhage]], [[ascites]], and [[encephalopathy]] are the markers of [[decompensation]]. | ||
* Some patients with Child B cirrhosis with portal hypertension but a low MELD score may be candidates for liver transplantation. | * Some patients with [[Child-Pugh B|Child B cirrhosis]] with [[portal hypertension]] but a low [[MELD Score|MELD score]] may be candidates for liver transplantation. | ||
* The transplantation evaluation is | * The transplantation evaluation is started once a patient has a MELD score >10. | ||
* Patients may also qualify for liver transplantation if they have a complication or condition that qualifies for standard MELD exception points | * Patients may also qualify for liver transplantation if they have a complication or condition that qualifies for standard MELD exception points: | ||
* Hepatocellular carcinoma | * [[Hepatocellular carcinoma]] | ||
* Hepatopulmonary syndrome | * [[Hepatopulmonary syndrome]] | ||
* Portopulmonary hypertension ( | * [[Portopulmonary hypertension]] (<35 mmHg ) | ||
* Familial amyloid polyneuropathy | * [[Familial amyloid polyneuropathy]] | ||
* Primary hyperoxaluria | * [[Primary hyperoxaluria]] | ||
* Cystic fibrosis | * [[Cystic fibrosis]] | ||
=== Liver neoplasms === | === Liver neoplasms === | ||
* Patients with some primary liver neoplasms may be candidates for liver transplantation, provided the neoplasms meet specific criteria | * [[Hepatocellular carcinoma]] | ||
* | * Patients with some primary [[liver neoplasms]] may be candidates for liver transplantation, provided the neoplasms meet specific criteria:<ref name="pmid24604263">{{cite journal| author=Eghtesad B, Aucejo F| title=Liver transplantation for malignancies. | journal=J Gastrointest Cancer | year= 2014 | volume= 45 | issue= 3 | pages= 353-62 | pmid=24604263 | doi=10.1007/s12029-014-9590-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24604263 }}</ref> | ||
* | * A single lesion ≤5 cm | ||
* Up to three separate lesions all <3 cm, no evidence of gross vascular invasion, and no regional nodal or distant [[Metastasis|metastases]] | |||
* Expansion criteria known as the Milan criteria for liver transplantation are for patients who are not candidates for resection and who have a single lesion ≤5 cm, no more than three separate lesions, none larger than 3 cm, no evidence of gross vascular invasion, and no regional nodal or distant [[Metastasis|metastases]].<ref name="pmid9174860">{{cite journal| author=Longeville JH, de la Hall P, Dolan P, Holt AW, Lillie PE, Williams JA et al.| title=Treatment of a giant haemangioma of the liver with Kasabach-Merritt syndrome by orthotopic liver transplant a case report. | journal=HPB Surg | year= 1997 | volume= 10 | issue= 3 | pages= 159-62 | pmid=9174860 | doi= | pmc=2423854 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9174860 }}</ref> | |||
* Large hepatic adenomas | * [[Hemangioendothelioma|Epithelioid hemangioendothelioma]]<ref name="pmid7848084">{{cite journal| author=Tepetes K, Selby R, Webb M, Madariaga JR, Iwatsuki S, Starzl TE| title=Orthotopic liver transplantation for benign hepatic neoplasms. | journal=Arch Surg | year= 1995 | volume= 130 | issue= 2 | pages= 153-6 | pmid=7848084 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7848084 }}</ref> | ||
* Large [[Hepatocellular adenoma|hepatic adenomas]] | |||
=== Metabolic disorders === | === Metabolic disorders === | ||
Liver-based metabolic conditions that have been treated with liver transplantation include:<ref name="pmid24019185">{{cite journal| author=Carey EJ, Iyer VN, Nelson DR, Nguyen JH, Krowka MJ| title=Outcomes for recipients of liver transplantation for alpha-1-antitrypsin deficiency–related cirrhosis. | journal=Liver Transpl | year= 2013 | volume= 19 | issue= 12 | pages= 1370-6 | pmid=24019185 | doi=10.1002/lt.23744 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24019185 }}</ref><ref name="pmid16083706">{{cite journal| author=Kowdley KV, Brandhagen DJ, Gish RG, Bass NM, Weinstein J, Schilsky ML et al.| title=Survival after liver transplantation in patients with hepatic iron overload: the national hemochromatosis transplant registry. | journal=Gastroenterology | year= 2005 | volume= 129 | issue= 2 | pages= 494-503 | pmid=16083706 | doi=10.1016/j.gastro.2005.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16083706 }}</ref><ref name="pmid18383093">{{cite journal| author=Tsuchiya A, Yazaki M, Kametani F, Takei Y, Ikeda S| title=Marked regression of abdominal fat amyloid in patients with familial amyloid polyneuropathy during long-term follow-up after liver transplantation. | journal=Liver Transpl | year= 2008 | volume= 14 | issue= 4 | pages= 563-70 | pmid=18383093 | doi=10.1002/lt.21395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18383093 }}</ref> | Liver-based metabolic conditions that have been treated with liver transplantation include:<ref name="pmid24019185">{{cite journal| author=Carey EJ, Iyer VN, Nelson DR, Nguyen JH, Krowka MJ| title=Outcomes for recipients of liver transplantation for alpha-1-antitrypsin deficiency–related cirrhosis. | journal=Liver Transpl | year= 2013 | volume= 19 | issue= 12 | pages= 1370-6 | pmid=24019185 | doi=10.1002/lt.23744 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24019185 }}</ref><ref name="pmid16083706">{{cite journal| author=Kowdley KV, Brandhagen DJ, Gish RG, Bass NM, Weinstein J, Schilsky ML et al.| title=Survival after liver transplantation in patients with hepatic iron overload: the national hemochromatosis transplant registry. | journal=Gastroenterology | year= 2005 | volume= 129 | issue= 2 | pages= 494-503 | pmid=16083706 | doi=10.1016/j.gastro.2005.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16083706 }}</ref><ref name="pmid18383093">{{cite journal| author=Tsuchiya A, Yazaki M, Kametani F, Takei Y, Ikeda S| title=Marked regression of abdominal fat amyloid in patients with familial amyloid polyneuropathy during long-term follow-up after liver transplantation. | journal=Liver Transpl | year= 2008 | volume= 14 | issue= 4 | pages= 563-70 | pmid=18383093 | doi=10.1002/lt.21395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18383093 }}</ref> | ||
* Familial amyloid polyneuropathy | * [[Familial amyloid polyneuropathy]] | ||
* Primary hyperoxaluria | * [[Primary hyperoxaluria]] | ||
* Cystic fibrosis | * [[Cystic fibrosis]] | ||
* Alpha-1 antitrypsin deficiency | * [[Alpha 1-antitrypsin deficiency|Alpha-1 antitrypsin deficiency]] | ||
* Some forms of glycogen storage disease | * Some forms of [[glycogen storage disease]] | ||
* Tyrosinemia: LT is performed in patients with persistent liver failure who do not respond to nitisinone therapy or have hepatic malignancy | * [[Tyrosinemia]]: LT is performed in patients with persistent liver failure who do not respond to nitisinone therapy or have hepatic malignancy | ||
* Hemochromatosis | * [[Hemochromatosis]] | ||
* Wilson disease: For those with advanced liver disease, a prognostic scoring system for children with Wilson disease presenting with failure was proposed by a group at Kings College and then later revised | * [[Wilson's disease|Wilson disease]]: For those with advanced liver disease, a prognostic scoring system for children with Wilson disease presenting with failure was proposed by a group at Kings College and then later revised. | ||
* Acute intermittent porphyria | * [[Acute intermittent porphyria]] | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:57, 18 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
|
Liver trasnsplantation Microchapters |
Overview
Indications
Acute liver failure
- Acute liver failure is defined by the development of severe acute liver injury with encephalopathy and impaired synthetic function.[1]
Cirrhosis
- Patients with cirrhosis are typically candidates for liver transplantation once their biologic Model for End-stage Liver Disease (MELD) score is ≥15.[2]
- Variceal hemorrhage, ascites, and encephalopathy are the markers of decompensation.
- Some patients with Child B cirrhosis with portal hypertension but a low MELD score may be candidates for liver transplantation.
- The transplantation evaluation is started once a patient has a MELD score >10.
- Patients may also qualify for liver transplantation if they have a complication or condition that qualifies for standard MELD exception points:
- Hepatocellular carcinoma
- Hepatopulmonary syndrome
- Portopulmonary hypertension (<35 mmHg )
- Familial amyloid polyneuropathy
- Primary hyperoxaluria
- Cystic fibrosis
Liver neoplasms
- Patients with some primary liver neoplasms may be candidates for liver transplantation, provided the neoplasms meet specific criteria:[3]
- A single lesion ≤5 cm
- Up to three separate lesions all <3 cm, no evidence of gross vascular invasion, and no regional nodal or distant metastases
- Expansion criteria known as the Milan criteria for liver transplantation are for patients who are not candidates for resection and who have a single lesion ≤5 cm, no more than three separate lesions, none larger than 3 cm, no evidence of gross vascular invasion, and no regional nodal or distant metastases.[4]
- Epithelioid hemangioendothelioma[5]
- Large hepatic adenomas
Metabolic disorders
Liver-based metabolic conditions that have been treated with liver transplantation include:[6][7][8]
- Familial amyloid polyneuropathy
- Primary hyperoxaluria
- Cystic fibrosis
- Alpha-1 antitrypsin deficiency
- Some forms of glycogen storage disease
- Tyrosinemia: LT is performed in patients with persistent liver failure who do not respond to nitisinone therapy or have hepatic malignancy
- Hemochromatosis
- Wilson disease: For those with advanced liver disease, a prognostic scoring system for children with Wilson disease presenting with failure was proposed by a group at Kings College and then later revised.
- Acute intermittent porphyria
References
- ↑ Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH; et al. (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann Intern Med. 137 (12): 947–54. PMID 12484709.
- ↑ Martin P, DiMartini A, Feng S, Brown R, Fallon M (2014). "Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation". Hepatology. 59 (3): 1144–65. PMID 24716201.
- ↑ Eghtesad B, Aucejo F (2014). "Liver transplantation for malignancies". J Gastrointest Cancer. 45 (3): 353–62. doi:10.1007/s12029-014-9590-2. PMID 24604263.
- ↑ Longeville JH, de la Hall P, Dolan P, Holt AW, Lillie PE, Williams JA; et al. (1997). "Treatment of a giant haemangioma of the liver with Kasabach-Merritt syndrome by orthotopic liver transplant a case report". HPB Surg. 10 (3): 159–62. PMC 2423854. PMID 9174860.
- ↑ Tepetes K, Selby R, Webb M, Madariaga JR, Iwatsuki S, Starzl TE (1995). "Orthotopic liver transplantation for benign hepatic neoplasms". Arch Surg. 130 (2): 153–6. PMID 7848084.
- ↑ Carey EJ, Iyer VN, Nelson DR, Nguyen JH, Krowka MJ (2013). "Outcomes for recipients of liver transplantation for alpha-1-antitrypsin deficiency–related cirrhosis". Liver Transpl. 19 (12): 1370–6. doi:10.1002/lt.23744. PMID 24019185.
- ↑ Kowdley KV, Brandhagen DJ, Gish RG, Bass NM, Weinstein J, Schilsky ML; et al. (2005). "Survival after liver transplantation in patients with hepatic iron overload: the national hemochromatosis transplant registry". Gastroenterology. 129 (2): 494–503. doi:10.1016/j.gastro.2005.05.004. PMID 16083706.
- ↑ Tsuchiya A, Yazaki M, Kametani F, Takei Y, Ikeda S (2008). "Marked regression of abdominal fat amyloid in patients with familial amyloid polyneuropathy during long-term follow-up after liver transplantation". Liver Transpl. 14 (4): 563–70. doi:10.1002/lt.21395. PMID 18383093.