immunology allergic disorders
Liver Transplantation
Introduction
Liver transplantation is the 2nd most common type of solid organ transplantation. (See also Overview of Transplantation .) Indicationsfor liver transplantation include Cirrhosis (70% of transplantations in the US; 10 to 20% of these cases are attributed to hepatitis C) Fulminant hepatic necrosis (about 8%) Hepatocellular Carcinoma (about 7%) Biliary Atresia and metabolic disorders, primarily in children (about 3% each) Other cholestatic (eg, Primary Biliary Cholangitis (PBC) ) and noncholestatic (eg, autoimmune hepatitis) disorders (about 8%) For patients with hepatocellular carcinoma, transplantation is indicated for 1 tumor<5 cm or up to 3 tumors<3 cm. These criteria plus the absence of extrahepatic and major vessel involvement satisfy the Milan criteria, used to assess suitability of liver transplantation for patients who have cirrhosis and hepatocellular carcinoma. For patients with liver metastases, transplantation is indicated only for neuroendocrine tumors without extrahepatic growth after removal of the primary tumor. Absolute contraindicationsto liver transplantation are Elevated intracranial pressure (> 40 mm Hg) or low cerebral perfusion pressure (< 60 mm Hg) in patients with fulminant hepatic necrosis Severe pulmonary hypertension (mean pulmonary arterial pressure > 50 mm Hg) Sepsis Advanced or metastatic hepatocellular carcinoma All of these conditions lead to poor outcomes during or after transplantation. 