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Guidelines for Referral

                                                                                  Liver Transplantation: Version 7.0

Guidelines for Referring a Patient for Liver Transplantation

        •    Life-threatening and progressive irreversible liver disease
        •    New onset ascites in a cirrhotic patient
        •    Ascites resistant to medical therapy
        •    Spontaneous bacterial peritonitis (SBP)
        •    Increasing fatigue in a cirrhotic patient so daily activities cannot be performed
        •    Onset of hepatic encephalopathy
        •    Progressive malnutrition and muscle wasting
        •    Recurrent bacterial cholangitis
        •    Symptomatic hepatopulmonary syndrome
        •    Onset of hepatorenal syndrome
        •    Fulminant hepatic failure
        •    Worsening synthetic function in a cirrhotic patient
        •    Decreasing serum albumin
        •    Rising prothrombin time
        •    Recurrent variceal hemorrhage
        •    Development of hepatocellular carcinoma within a cirrhotic liver  

Note:  Patients with cholangiocarcinoma do not do well with liver transplant and generally are not considered candidates for evaluation.

1 Steinman TI, Becker BN, Frost AE, et al. Guidelines or the referral and management of patients eligible for solid organ transplantation. Transplantation 2001;71:1189. © 2001 Lippincott, Williams and Wilkins.