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Assessment for Liver Transplantation

University of Wisconsin School of Medicine, mrl{at}medicine.wisc.edu

Selection of recipients for liver transplantation is based on 1) the severity and prognosis of the patient's liver disease; 2) related medical, surgical, and psychological factors; and 3) the desires of the patient. Severity of liver failure in patients with chronic liver disease is assessed by the Child-Pugh classification and the MELD (model for end-stage disease based) score. The Child-Pugh classification is based on empiric evaluation of 1) ascites, 2) encephalopathy, 3) prothrombin time, 4) serum bilirubin, and 5) serum albumin. The MELD score is based on 1) INR, 2) serum bilirubin, and 3) serum creatinine. The timing of placement of patients on the waiting list is based on assessment of stable versus decompensated cirrhosis. In the United States, patients are centrally listed and organs are first allocated to the sickest patient. Priority is given to patients with fulminant hepatic failure or primary allograft nonfunction. Suitability for transplant includes cardiac, pulmonary, renal, endocrine, oncological, infectious, nutritional, and psychological assessments.

Key Words: liver transplantation • Child-Turcotte-Pugh classification • porto-pulmonary hypertension • fulminant hepatic failure

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