Liver transplant candidacy unsuitability: a review of the British Columbia experience.
BACKGROUND
Every centre has contraindications to liver transplantation and declares patients unsuitable for medical or nonmedical reasons. To date, there has been no published review of any centre's experience.


METHODS
A retrospective chart review was completed from 1997 to 2001, inclusive of all patients referred for liver transplant to the British Columbia Transplant Society who were declared unsuitable for transplantation, as well as the reasons for unsuitability.


RESULTS
One hundred fifty patients were considered to be unsuitable for transplantation. During this period, 167 transplants were performed and 737 patients were referred for candidacy. Data were missing on three patients; analysis was performed on the remaining 147. Patients' ages ranged from 15 to 72 years, and 33.3% were female. The most common primary liver disease was hepatitis C (n=53, 35%), followed by alcoholic liver disease (n=35, 24%) and autoimmune liver diseases (n=23, 16%). Medical contraindications constituted 74 patients (49.0%) and the most common reasons for unsuitability were no need of a liver transplant (29 patients [39%]), exclusion due to hepatoma or extrahepatic malignancy (20 patients [27%]) and multisystem failure (12 patients [16%]). Nonmedical contraindications constituted 73 patients. Failure to meet minimal alcohol criteria comprised the largest group (n=39, 53.4%) followed by inadequate social support (n=12, 16.4%), failure to follow up medical assessment (n=10, 13.7%) and drug abuse (n=6, 8.2%).


CONCLUSIONS
Although many patients were declined for transplantation, the proportion is relatively small compared with the number of referred patients. Nonmedical reasons, including failure to meet alcohol criteria and lack of social support, remain a significant reason for unsuitability in British Columbia. Community intervention before transplant referral is recommended.
Department of Medicine, University of British Columbia.
Jaber
J
Alali
Alnoor
A
Ramji
Jin K
JK
Ho
Charles H
CH
Scudamore
Siegfried R
SR
Erb
Elsie
E
Cheung
Bina
B
Kopit
Clare A
CA
Bannon
Stephen W
SW
Chung
John G
JG
Soos
Andrezj K
AK
Buczkowski
Eileen M
EM
Brooks
Urs P
UP
Steinbrecher
Eric M
EM
Yoshida
D000293:Adolescent; D000328:Adult; D000368:Aged; D001955:British Columbia; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008108:Liver Diseases, Alcoholic / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012944:Social Support