Hepatic Patient Selection Criteria

Indications

In general, liver transplantation is indicated in children and adults suffering from irreversible liver dysfunction or the effects of liver dysfunction after alternative medical and surgical treatments have been utilized and where the benefits of transplantation out weigh the risk of alternative modalities.

Specific Indications

1. Acute hepatic fulminant failure
2. Extrahepatic biliary atresia or hypoplasia
3. Inborn errors of metabolism:
   
   • a. Alpha-I antitrypsin deficiency
   • b. Crigler-Najjar disease, Type I
   • c. Byler's disease
   • d. Glycogen storage disease (O and IV)
   • e. Wilson's disease
   • f. Hemochromatosis
   • g. Tyrosinemia
   • h. Wolman's disease
   • i. Familial amyloidotic polyneuropathy (FAP)
   • j. Primary hyperoxaluria type 1
   • k. Other
4. Sclerosing cholangitis
5. Hepatic vein thrombosis (Budd-Chiari)
6. Hepatocellular Carcinoma (HCC), Stage I or II, or: single lesion </= 6.5 cm, or multiple lesions (</=3) with the largest </= 4.5 cm with total maximum tumor diameter </= 8 cm (UCSF criteria)
7. Cirrhosis:
   
   • a. Alcohol cirrhosis (see Alcohol or Substance Dependence Addendum)
   • b. Biliary cirrhosis (primary or secondary): Caroli, choledochal cyst, congenital cholestasis (PFIC), iatrogenic biliary tree injury/damage, trauma
   • c. Chronic active hepatitis (A, B, C, non A, non B, autoimmune)
   • d. Congenital biliary cirrhosis
   • e. Cryptogenic cirrhosis
   • f. Cystic fibrosis
   • g. Hemochromatosis
   • h. Alpha I Antitrypsin Deficiency
   • i. NASH
   • j. Viral cirrhosis
   • k. Other
8. Congenital hepatic fibrosis
9. Controlled biliary sepsis resulting from acute (or chronic) hepatic artery thrombosis (ischemic coagulopathy)
10. Hepato-pulmonary syndrome, with cirrhosis
11. Polycystic liver disease with symptoms such as: portal hypertension, Budd-Chiari-like symptoms, refractory and unmanageable ascites following cyst fenestration
12. Porto-pulmonary hypertension in the presence of cirrhosis and mean pulmonary artery pressures of < 35 mm Hg

Indications for Retransplantation

1. Primary non-function
2. Irreversible vascular compromise of either the hepatic artery, portal vein, or hepatic vein
3. Recurrent primary disease
4. Intractable, acute, or chronic rejection
5. Biliary disease not correctable by any mechanism other than transplantation
6. Small for size syndrome
7. Poor early graft function (PEGF)

Indications Special Cases (To be reviewed on a case-by-case basis)

1. Stage III tumors outside UCSF
2. Slow-growing metastatic leiomyosarcoma, neuroendocrine tumors including metastatic carcinoid syndrome and hemangioendotheliomas
3. Cholangiocarcinoma transplanted under approved institutional protocol
4. Hepatitis C (retransplant within 1 year for recurrent disease)

Contraindications

1. Chemical dependency (see Alcohol or Substance Dependency Addendum)
2. Active infection outside hepatobiliary system limiting survival
3. Significant cardiac, pulmonary, or nervous system failure (this does not apply for patients being considered for heart and/or lung transplant)
4. Unstable current psychotic disease (pre-liver failure)
5. Uncontrolled malignancy
6. AIDS
7. Persistent pattern of non-compliance considered likely to interfere with following a disciplined medical regime