Transplant is recommended when the risk of demise from the liver condition outweighs the immediate and long term risks of a liver transplant.
If a transplant is performed prematurely, the patient will be subjected to unnecessary surgical risk as well as the risks of long term immunosuppressants. If the transplant is unnecessarily delayed, it may jeopardise the curative effectiveness of the transplant as well as make the transplant surgery more complicated. In some conditions, it may be too advanced for transplant to be of any benefit.
Some common conditions for which a liver transplant is recommended include:
1) Various cancers such as:
Hepatocellular carcinoma
Cholangiocarcinoma
Metastatic neuroendocrine tumours
2) Various causes of cirrhosis (liver hardening and loss of function) such as:
Autoimmune hepatitis
Hepatitis B or Hepatitis C
Alcoholic liver disease
3) Biliary diseases such as:
- Primary biliary cirrhosis
- Secondary biliary cirrhosis
- Sclerosing cholangitis
4) Primary metabolic diseases such as [1]:
- Alpha1-antitrypsin deficiency
- Wilson’s disease
- Polycystic disease
- Familial amyloidosis
For the cancers, liver transplant may not be helpful if the cancer has disseminated beyond the liver and these patients should not get a liver transplant [2]. For some of the other conditions, the liver disease may be associated with disease of other organs or may worsen the function of other organs and make the transplant too risky.
References:
1. Moini M, Mistry P, Schilsky ML. Liver transplantation for inherited metabolic disorders of the liver. Current opinion in organ transplantation. 2010;15(3):269-276.
2. Lai JC. Defining the threshold for too sick for transplant. Current Opinion in Organ Transplantation. 2016;21(2):127-132.
