Prognostic factors associated with a poor outcome for a patient with severe alcoholic cirrhosis:
(1) continuing to drink
(2) initial renal failure
(3) initial elevation of serum sodium (hypernatremia)
Indications for liver transplantation for alcoholic cirrhosis - all of the following:
(1) Child C cirrhosis
(2) severe complications (refractory ascites, chronic encephalopathy, extreme fatigue, recurrent hemorrhage)
(3) persisting liver failure after 6 months of abstinence from alcohol
(4) failure to respond to conservative management
(5) absence of contraindications
Some patients who become abstinent have sufficient improvement of liver function that a liver transplant may not be necessary.
A patient who has failed to have improvement in liver function despite 3 months of abstinence is unlikely to improve in the subsequent 3 months, so should be considered for liver transplant if the other criteria are met.
Contraindications to liver transplantation:
(1) continuing to drink
(2) hepatocellular carcinoma not suitable for liver transplantation
(3) advanced age
(4) psychosis or other severe psychiatric disorder
(5) other contraindications
