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Digestive Disease Interventions 2019; 03(04): 255-262
DOI: 10.1055/s-0039-1700515
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pre-Liver Transplantation Evaluation and Listing

Alexander Pan 
1   Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
,
Sean Koppe
1   Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

18 April 2019

07 August 2019

Publication Date:
21 November 2019 (online)

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Abstract

Liver transplantation provides a curative treatment option for patients with both acute and chronic liver disease, but the decision to list a patient for transplant should be an informed one to maximize post-transplantation benefit and survivability. Potential candidates meeting transplantation indications must undergo a comprehensive evaluation consisting of both physical, as well as psychiatric, assessment to be considered for transplantation. Once listed, a candidate's place on the liver transplant waiting list is determined predominantly by his or her Model for End-Stage Liver Disease (MELD)-Na score, which is a reliable tool to stratify short-term survival risk. The severity of certain conditions, however, is not accurately reflected by the MELD-Na score, and these particular diagnoses may be assigned MELD exception points. Herein, we discuss common indications for liver transplantation: the MELD system and its exceptions, the physical and psychosocial evaluation of potential transplant candidates, and some limitations of the current organ allocation system and efforts to reduce disparity in organ distribution.

Keywords

liver transplantation - MELD - MELD exception - hepatocellular carcinoma - Milan criteria - downstaging
 

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