title: Assessment of adult patients with chronic liver failure for liver transplantation in 2015: who and when?
abstract: In 2015, there are a few absolute contraindications to liver transplantation. In adult patients, survival post-liver transplant is excellent, with 1-year survival rate >90% and 5-year survival rates >80% and predicted median allograft survival beyond 20 years. Patients with a Child-Turcotte Pugh score ≥9 or a model for end-stage liver disease (MELD) score >15 should be referred for liver transplantation, with patients who have a MELD score >17 showing a 1-year survival benefit with liver transplantation. A careful selection of hepatocellular cancer patients results in excellent outcomes, while consideration of extra-hepatic disease (reversible vs irreversible) and social support structures are crucial to patient assessment. Alcoholic liver disease remains a challenge, and the potential to cure hepatitis C virus infection together with the emerging issue of non-alcoholic fatty liver disease-associated chronic liver failure will change the landscape of the who in the years ahead. The when will continue to be determined largely by the severity of liver disease based on the MELD score for the foreseeable future.
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Liver Injury and Cancer Group, Centenary Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: G W
authors.initials: GW
authors.lastname: McCaughan
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Crawford
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Sandroussi
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Koorey
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Liver Injury and Cancer Group, Centenary Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: D G
authors.initials: DG
authors.lastname: Bowen
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Liver Injury and Cancer Group, Centenary Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: N A
authors.initials: NA
authors.lastname: Shackel
authors.affiliation: Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: S I
authors.initials: SI
authors.lastname: Strasser
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000523:psychology / Q000639:trends*; D018579:Patient Selection; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D066027:Transplant Recipients / Q000523:psychology
keywords: chronic liver failure; extra-hepatic disease; liver transplantation; outcomes