Abstract

Liver Transplantation and SurgeryVolume 3, Issue 6 p. 628-637 Original ArticleFree Access Minimal criteria for placement of adults on the liver transplant waiting list: A report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases M R Lucey, M R Lucey Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorK A Brown, K A Brown Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorG T Everson, G T Everson Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorJ J Fung, J J Fung Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorR Gish, R Gish Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorE B Keeffe, E B Keeffe Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorN M Kneteman, N M Kneteman Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorJ R Lake, J R Lake Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorP Martin, P Martin Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorS V McDiarmid, S V McDiarmid Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorJ Rakela, J Rakela Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorM L Shiffman, M L Shiffman Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorS K So, S K So Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorR H Wiesner, R H Wiesner Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this author M R Lucey, M R Lucey Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorK A Brown, K A Brown Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorG T Everson, G T Everson Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorJ J Fung, J J Fung Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorR Gish, R Gish Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorE B Keeffe, E B Keeffe Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorN M Kneteman, N M Kneteman Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorJ R Lake, J R Lake Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorP Martin, P Martin Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorS V McDiarmid, S V McDiarmid Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorJ Rakela, J Rakela Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorM L Shiffman, M L Shiffman Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorS K So, S K So Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this authorR H Wiesner, R H Wiesner Committee for Liver and Intra-abdominal Organs, American Society of Transplant Physicians, USASearch for more papers by this author First published: 30 December 2003 https://doi.org/10.1002/lt.500030613Citations: 281AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library 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Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract This report summarizes a recent meeting cosponsored by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases to formulate minimal criteria by which patients with severe liver disease will be placed on the waiting list for liver transplantation. The participants agreed that only patients in immediate need of liver transplantation should be placed on the waiting list. Patients should not be placed in anticipation of some future need for such therapy. It was agreed that minimal criteria could assist but not replace the clinical judgment of the transplant professionals at individual centers. The criteria will be summarized below for adult patients with acute or chronic liver disease. The most important non- disease-specific criterion for placement on the transplant waiting list was an estimated 90% chance of surviving 1 year. This translated into a Child-Pugh score of ≥ 7 for patients with cirrhosis which places the patient in Child-Pugh class B or C. Cirrhotic patients who have experienced gastrointestinal bleeding caused by portal hypertension or a single episode of spontaneous bacterial peritonitis would meet the minimal criteria irrespective of their Child-Pugh score. There were disease-specific criteria also. These include a sole minimal criterion for patients with fulminant hepatic failure regardless of etiology of the onset of stage 2 hepatic encephalopathy. A requirement for 6 months abstinence from alcohol before placement on the transplant waiting list was considered appropriate for most patients with alcoholic liver disease. Exceptional cases could get access to the waiting list through a regional review process. Chronic cholestatic diseases present difficulties because of a different natural history than that of chronic hepatocellular diseases. The use of specific risk scores for primary biliary cirrhosis and primary sclerosing cholangitis will likely replace Childs-Pugh classification as the scoring systems become refined. Minimal criteria for any patient with a primary hepatocellular cancer would admit any patient with a tumor confined to the liver irrespective of size or number of tumors, after careful investigation had failed to show spread to lymph nodes, the portal vein, or distant organs. Unusual or rare indications for liver transplantation, including Budd-Chiari syndrome, Wilson's disease, and other hereditary disorders, were also discussed. Finally, it was agreed that there should be no absolute contraindications to placement of patients on the liver transplant waiting list. These criteria should be open to regular review to accommodate advances in the field. Citing Literature Volume3, Issue6November 1997Pages 628-637 RelatedInformation