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What is liver transplant criteria?

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Liver transplant criteria are essential guidelines used to determine eligibility for liver transplantation. These criteria are crucial in ensuring the appropriate allocation of limited donor organs to patients who would benefit the most from the procedure. Several studies have contributed to defining specific criteria for different conditions necessitating liver transplantation.

For instance, in the context of hepatocellular carcinoma (HCC), the Milan criteria have been widely accepted as validated criteria for liver transplantation (Samuel & Coilly, 2018; Kawamura & Taketomi, 2020; Decaens et al., 2006; Gao et al., 2021; Dueland et al., 2018). These criteria typically involve parameters such as tumor size, number of nodules, and vascular invasion to assess the suitability of candidates for liver transplantation. Additionally, expanded criteria for liver transplant in HCC have been proposed, considering factors like vascular invasion, distant metastasis, and cytology status (Haberal et al., 2017).

In cases of acute liver failure, specific criteria such as the King’s College criteria are applied to determine the need for urgent liver transplantation (Lee et al., 2011; Madl et al., 1994; Xu et al., 2021). These criteria help in identifying patients with poor prognoses who would benefit from timely transplantation. Moreover, for patients with severe alcoholic hepatitis, liver transplantation may be considered as a rescue option if they meet certain criteria, including failed medical management and thorough psychosocial assessment (Dureja & Lucey, 2010; Jauhar et al., 2004).

Furthermore, in the context of liver metastases from neuroendocrine tumors, specific inclusion criteria have been outlined, including tumor differentiation, portal drainage, liver involvement percentage, age, and disease stability (Nagai, 2023; Mazzaferro et al., 2016). These criteria help in selecting appropriate candidates for liver transplantation in this specific condition.

Overall, the establishment and refinement of liver transplant criteria, such as the Milan criteria for HCC and the King’s College criteria for acute liver failure, play a crucial role in ensuring the optimal utilization of donor organs and improving patient outcomes post-transplantation.

References #

  1. Decaens, T., Roudot‐Thoraval, F., Hadni-Bresson, S., Meyer, C., Gugenheim, J., Durand, F., … & Duvoux, C. (2006). Impact of ucsf criteria according to pre- and post-olt tumor features: analysis of 479 patients listed for hcc with a short waiting time. Liver Transplantation, 12(12), 1761-1769. https://doi.org/10.1002/lt.20884
  2. Dueland, S., Foss, A., Solheim, J., Hagness, M., & Line, P. (2018). Survival following liver transplantation for liver-only colorectal metastases compared with hepatocellular carcinoma. British Journal of Surgery, 105(6), 736-742. https://doi.org/10.1002/bjs.10769
  3. Dureja, P. and Lucey, M. (2010). The place of liver transplantation in the treatment of severe alcoholic hepatitis. Journal of Hepatology, 52(5), 759-764. https://doi.org/10.1016/j.jhep.2009.12.021
  4. Gao, Q., Anwar, I., Abraham, N., & Barbas, A. (2021). Liver transplantation for hepatocellular carcinoma after downstaging or bridging therapy with immune checkpoint inhibitors. Cancers, 13(24), 6307. https://doi.org/10.3390/cancers13246307
  5. Haberal, M., Akdur, A., Moray, G., Arslan, G., Özçay, F., Selçuk, H., … & Ozdemir, B. (2017). Untitled. Experimental and Clinical Transplantation, 15(Suppl 2). https://doi.org/10.6002/ect.tond16.l14
  6. Jauhar, S., Talwalkar, J., Schneekloth, T., Jowsey, S., Wiesner, R., & Menon, K. (2004). Analysis of factors that predict alcohol relapse following liver transplantation. Liver Transplantation, 10(3), 408-411. https://doi.org/10.1002/lt.20086
  7. Kawamura, N. and Taketomi, A. (2020). Liver transplantation for locally advanced hepatocellular carcinoma. Digestive Disease Interventions, 04(01), 003-012. https://doi.org/10.1055/s-0040-1702996
  8. 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. https://doi.org/10.1111/j.1365-2893.2010.01295.x
  9. Madl, C., Grimm, G., Ferenci, P., Kramer, L., Yeganehfar, W., Oder, W., … & Lenz, K. (1994). Serial recording of sensory evoked potentials: a noninvasive prognostic indicator in fulminant liver failure. Hepatology, 20(6), 1487-1494. https://doi.org/10.1002/hep.1840200618
  10. Mazzaferro, V., Sposito, C., Coppa, J., Miceli, R., Bhoori, S., Bongini, M., … & Mariani, L. (2016). The long-term benefit of liver transplantation for hepatic metastases from neuroendocrine tumors. American Journal of Transplantation, 16(10), 2892-2902. https://doi.org/10.1111/ajt.13831
  11. Nagai, S. (2023). Transplant oncology: multivisceral transplantation for neuroendocrine tumor and liver metastasis. Current Opinion in Organ Transplantation, 28(3), 222-227. https://doi.org/10.1097/mot.0000000000001063
  12. Samuel, D. and Coilly, A. (2018). Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation. BMC Medicine, 16(1). https://doi.org/10.1186/s12916-018-1110-y
  13. Xu, Y., Testro, A., & Wong, A. (2021). Analysis of the australia and new zealand referral criteria for transfer to a liver unit for paracetamol overdose. Emergency Medicine Australasia, 33(6), 1021-1026. https://doi.org/10.1111/1742-6723.13795