title: [Liver transplantation in the adult: who and when to transplant?].
abstract: BACKGROUND
  The shortage of cadaveric organ donors imposes a severe limit to the number of liver transplantations. A selection is thus necessary among patients: should the sickest be selected, or those who supposedly have the best chance to survive and recover? Optimizing the timing of transplantation during the course of the disease (not too early, but not too late) is another issue.
  
  
  BACKGROUND
  Suitable candidates for transplantation are patients suffering from an irreversible, symptomatic liver disease. The goals of therapy are: firstly, to favorably modify the natural outcome of the disease; and secondly, in an acceptable risk taking manner. Major criteria for indication in the most common liver diseases can be summarized as follows: a) for chronic parenchymal liver diseases, a Child-Pugh score of 9 or 10, or less if complications have already occurred, is a mandatory and often sufficient criterion; b) for cholestatic liver diseases, a serum bilirubin level higher than 100-150 mumol/L is generally required; c) apart from "small" hepatocellular carcinomas on cirrhotic parenchyma (less than three tumors of less than 5 cm in diameter), most cancers are considered contraindications; d) acute liver failure requires early referral to a liver transplant center for potential emergency indication.
  
  
  CONCLUSIONS
  In an organ shortage situation which is likely to perdure, early consultative contact between the patient and the liver transplant team will allow improvement in the access to transplantation procedure.
authors.affiliation: Service de chirurgie générale et transplantation hépatique, hôpital de La Conception, Marseille, France.
authors.forename: Y P
authors.initials: YP
authors.lastname: Le Treut
authors.forename: P
authors.initials: P
authors.lastname: Castellani
authors.forename: B
authors.initials: B
authors.lastname: Pol
authors.forename: P
authors.initials: P
authors.lastname: Campan
authors.forename: J
authors.initials: J
authors.lastname: Hardwigsen
authors.forename: D
authors.initials: D
authors.lastname: Botta-Fridlund
mesh_terms: D000328:Adult; D000075202:Contraindications; D018450:Disease Progression; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D018579:Patient Selection; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome