2014, Number 6
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Rev Invest Clin 2014; 66 (6)
Indications for liver transplant
Aguirre-Valadez J, Torre A, Vilatobá M, Contreras AG, Sánchez-Cedillo A, Antolinez-Motta J, García-Juárez I
Language: Spanish
References: 86
Page: 534-546
PDF size: 183.73 Kb.
ABSTRACT
Liver transplantation (LT) is the treatment of choice in selected
patients with end-stage liver disease and in some with
acute liver failure, hepatocellular carcinoma (HCC) and
other diseases with no synthetic liver failure. Currently, LT
has an overall survival › 90 % at 1 year. Proper selection of
LT candidates is important given the shortage in organ donation.
The allocation and priorization of organs to patients
with chronic liver failure (CLF) in waiting lists, is determined
by the MELD priority score (Model of End Stage Liver
Disease). Indications for LT in patients with CLF are the
same regardless of the etiology (any type of hepatic decompensation
or development of HCC). Priority MELD is a variant
to this classification used only in special cases such as
in those with stable hepatopathy but severe extra-hepatic features
(e.g., HCC or hepato-pulmonary syndrome). The indication
for LT in patients with acute liver failure (ALF) and
acute failure associated to chronic liver failure (ACLF) are
not fully established; there are prognostic factors that may
guide the decision for urgent LT and some centers, like the
King’s College Hospital criteria in the UK. Currently, LT is
a therapeutic modality in some primary liver tumors (HCC,
cholangiocarcinoma) and neuroendocrine liver metastatic
tumors. These protocols have provided significant opportunities
for long-term survival (› 70% at 5 years). The high
demand and shortage of organs have fostered the development
of new strategies to benefit more patients, such as the
use of extended criteria donors, or “domino” transplants.
This review focuses on the most relevant data on the different
indications of LT.
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