Expert Opinion

Get A Second Opinion

The medical second opinion will be presented to you within 48 hours.

What disqualifies you from a liver transplant?

Table of Contents

Liver transplant candidates can be disqualified based on various medical and psychosocial factors. These factors include being too well, too sick, too old, or having comorbid medical or psychosocial conditions (Secunda et al., 2013). Specific contraindications for liver transplantation can include conditions such as recent extrahepatic malignancies, uncontrolled infections, severe pulmonary hypertension, substance abuse, severe alcoholic hepatitis, advanced cardiac disease, aggressive hepatosplenic alphabeta T-cell lymphoma, portal vein thrombosis, cholangiocarcinoma, metastatic colorectal cancer to the liver, and end-stage alcoholic liver disease (Morrell et al., 2019; Miserachs & Ng, 2016; Syed et al., 2020; Benedetti et al., 1999; “Fulminant Liver Failure Induced by Hepatosplenic αβ T-Cell Lymphoma”, 2003; Qu et al., 2022; Batey, 1996; Hagness, 2015; Kodali et al., 2022; Alavian et al., 2012; Ling et al., 2010; Amir et al., 2016; Lee et al., 2011). Additionally, factors like HIV seropositivity, hepatitis B virus infection, and diabetes mellitus can also impact candidacy for liver transplantation (Wall et al., 2019; Alavian et al., 2012; Ling et al., 2010).

In the context of liver transplantation, certain conditions are considered relative contraindications, such as preexisting diabetes mellitus, which can lead to higher morbidity and mortality post-transplantation (Ling et al., 2010). Moreover, the presence of extrahepatic infections, advanced pulmonary tuberculosis, and systemic conditions like hemophagocytic lymphohistiocytosis are also considered contraindications due to the risk of recurrence and poor outcomes (Donataccio et al., 2011; Amir et al., 2016). Furthermore, end-stage alcoholic liver disease has been historically viewed as a relative or absolute contraindication to liver transplantation in many centers (Batey, 1996; Schenker et al., 1990).

In summary, liver transplant candidacy can be affected by a range of medical and psychosocial factors, with specific conditions serving as contraindications due to their impact on transplant outcomes and patient survival. It is essential for transplant centers to carefully evaluate each candidate to ensure the best possible outcomes post-transplantation.

References:  #

  1. (2003). Fulminant liver failure induced by hepatosplenic αβ t-cell lymphoma. Zeitschrift Für Gastroenterologie, 41(11), 1083-1086.
  2. Alavian, S., Lankarani, K., Rizzetto, M., Marzano, A., Moghadami, M., Nik-Eghbolian, S., … & Bahrani, A. (2012). Management of hepatitis b virus infection in liver transplantation setting; the rising concerns and growing hopes, report from 10th congress of the iranian society for organ transplantation, 2011, shiraz, iran. Hepatitis Monthly, 12(12).
  3. Amir, A., Ling, S., Naqvi, A., Weitzman, S., Fecteau, A., Grant, D., … & Avitzur, Y. (2016). Liver transplantation for children with acute liver failure associated with secondary hemophagocytic lymphohistiocytosis. Liver Transplantation, 22(9), 1245-1253.
  4. Batey, R. (1996). The case for liver transplantation in end‐stage alcoholic liver disease. Drug and Alcohol Review, 15(2), 183-188.
  5. Benedetti, E., Massad, M., Chami, Y., Wiley, T., & Layden, T. (1999). Is the presence of surgically treatable coronary artery disease a contraindication to liver transplantation?. Clinical Transplantation, 13(1), 59-61.
  6. Donataccio, D., Bravo, P., Masotto, A., Ceola, M., Calabrò, F., & Donataccio, M. (2011). Liver transplantation in a monolung patient: a strategy of sequential treatments of multiple lung tuberculosis ca-vitations and hepatocellular carcinoma on hepatitis b related virus cirrhosis. Surgical Science, 02(05), 257-261.
  7. Hagness, M. (2015). Liver transplantation in treatment of colorectal liver metastases. Hepatic Oncology, 2(2), 181-190.
  8. Kodali, S., Saharia, A., & Ghobrial, R. (2022). Liver transplantation and intrahepatic cholangiocarcinoma: time to go forward again?. Current Opinion in Organ Transplantation, 27(4), 320-328.
  9. Lee, W., Chou, H., Wu, T., Lee, C., Lee, C., & Chan, K. (2011). Indicators and outcome of liver transplantation in acute liver decompensation after flares of hepatitis b. Journal of Viral Hepatitis, 18(3), 193-199.
  10. Ling, Q., Xu, X., Wei, Q., Wei, X., Wang, Z., Zhou, L., … & Zheng, S. (2010). Impact of preexisting diabetes mellitus on outcome after liver transplantation in patients with hepatitis b virus-related liver disease. Digestive Diseases and Sciences, 56(3), 889-893.
  11. Miserachs, M. and Ng, V. (2016). Pediatric recipient considerations., 1-10.
  12. Morrell, M., Kiel, S., & Pilewski, J. (2019). Organ transplantation for cystic fibrosis. Seminars in Respiratory and Critical Care Medicine, 40(06), 842-856.
  13. Qu, W., Zhu, Z., & Lin, W. (2022). A novel approach for portal system reconstruction in liver transplant patients with grade iv portal vein thrombosis: case study and literature review. Frontiers in Transplantation, 1.
  14. Schenker, M., Perkins, S., & Sorrell, F. (1990). Should patients with end-stage alcoholic liver disease have a new liver?. Hepatology, 11(2), 314-319.
  15. Secunda, K., Gordon, E., Sohn, M., Shinkunas, L., Kaldjian, L., Voigt, M., … & Levitsky, J. (2013). National survey of provider opinions on controversial characteristics of liver transplant candidates. Liver Transplantation, 19(4), 395-403.
  16. Syed, A., Sadler, M., Borman, M., Burak, K., & Congly, S. (2020). Assessment of canadian policies regarding liver transplant candidacy of people who use alcohol, tobacco, cannabis, and opiates. Canadian Liver Journal, e20200005.
  17. Wall, A., Lee, G., Maldonado, J., & Magnus, D. (2019). Medical contraindications to transplant listing in the usa: a survey of adult and pediatric heart, kidney, liver, and lung programs. World Journal of Surgery, 43(9), 2300-2308.