Indications of liver transplantation in patients with complications of cirrhosis.
Transplantation is the only option for reversing liver insufficiency and its complications in patients with end-stage cirrhosis. Transplantation is generally considered after the first episode of decompensation of cirrhosis, provided no specific intervention can result in a longstanding return to the compensated state. Alcohol abuse and hepatitis C virus infection are the predominant causes leading to transplantation in Western countries. In cases of alcoholic cirrhosis, a 6-month period of abstinence is needed before transplantation. Patients with hepatitis C virus infection are considered independent of viral replication, even if post-transplantation recurrence is almost constant. Conversely, in cases of hepatitis B infection, only patients without viral replication (or with extremely low viral load) are suitable candidates. Hepatocellular carcinoma represents an increasing proportion of the indications and offers excellent long-term survival. However, transplantation should be limited to patients with small tumours. HIV infection no longer represents a definitive contraindication.
Francoz
Claire
C
Service d'Hépatologie, INSERM, Bichat Beaujon, Clichy, France.
Belghiti
Jacques
J
Durand
François
F
D000075202:Contraindications; D015276:Health Care Rationing; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists