Summary of guidelines on organ allocation and patient listing for liver transplantation.
In summary, a Child-Pugh class A cirrhotic patient without decompensation has a relatively long and stable natural history, but poor survival once decompensation with ascites or variceal bleeding has occurred. Thus, reasonable criteria for listing a patient for liver transplantation should be clinical decompensation of cirrhosis, particularly ascites or variceal bleeding, or combined clinical decompensation and biochemical deterioration of hepatic synthetic function that meets criteria for Child-Pugh class B or C status. On the basis of analysis of data regarding the natural history of compensated and decompensated cirrhosis, general principles of a minimal listing criteria were proposed (Table 5). These principles were used to establish non-disease-specific minimal listing criteria that are broadly applicable to all types of chronic liver diseases (Table 6). Some examples of proposed disease-specific minimal listing criteria are shown in Table 7.
Keeffe
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Department of Medicine, Stanford University School of Medicine, CA, USA.
D017408:Guidelines as Topic; D015276:Health Care Rationing / Q000592:standards; D006801:Humans; D016031:Liver Transplantation / Q000592:standards*; D018579:Patient Selection; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000592:standards*; D019737:Transplants / Q000600:supply & distribution; D014481:United States