Candidates for liver transplant can be classified into different groups such as super urgent or elective. A super urgent candidate must meet certain requirements.
Patient selection: liver transplantation
Parameters:
(1) etiology or situation
(2) clinical and/or laboratory findings
Etiology/Situation |
Clinical or Laboratory Findings |
Category |
paracetamol |
pH < 7.25 > 24 hours after overdose and after fluid resuscitation |
1 |
paracetamol |
coagulopathy (PT > 100 s or INR > 6.5) AND renal disease (anuria, serum creatinine > 300 µmol/L) AND encephalopathy grade >= 3 |
2 |
paracetamol |
serum lactate > 24 hours after overdose: on admission > 3.5 mmol/L or after fluid resuscitation > 3.0 mmol/L |
3 |
paracetamol |
2 items from Category 2 with clinical deterioration in absence of sepsis |
4 |
hepatitis |
coagulopathy (PT > 100 s or INR > 6.5) and any grade of hepatic encephalopathy |
5 |
hepatitis |
any grade of encephalopathy AND >= 3 of the following: unfavorable etiology; age > 40 years; jaundice to encephalopathy time > 7 days; serum bilirubin > 300 µmol/L; PT > 50 s or INR > 3.5 |
6 |
Wilson's disease or Budd-Chiari |
acute with coagulopathy and any grade of encephalopathy |
7 |
liver transplant recipient |
hepatic artery thrombosis on days 0 to 21 after transplant |
8 |
liver transplant recipient |
early graft dysfunction <= 7 days after transplant with >=2 of the following: AST > 10000 IU/L; INR > 3; serum lactate > 3 mmol/L; absence of bile production |
9 |
liver transplant donor |
severe liver failure within 4 weeks of the donation |
10 |
where:
• Signs of clinical deterioration: increased intracranial pressure; FIO2 > 50%; increasing inotrope requirements, etc.
• Hepatitis: seronegative, hepatitis A, hepatitis B, drug-induced
• Unfavorable etiology for hepatitis: idiosyncratic drug reaction or seronegative hepatits.
Specialty: Gastroenterology