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Indications for liver transplant surgery
The recommendation followed by most authors and institutions is evaluating the 1-year survival prognosis of the patient. A liver transplant could be recommended if the patient has a severe liver condition with a very poor prognosis. Patients with less than 90% of estimated survival in the next year are probably good candidates for liver transplant surgery regardless of the nature of the liver disease.
Thus, being diagnosed with cirrhosis is not by itself a recommendation of liver transplantation. There are different types of cirrhosis, and one of them is a compensated disease that does not require surgical treatment. However, suppose the patient with cirrhosis has variceal bleeding, hepatorenal syndrome, spontaneous bacterial peritonitis, and other signs of decompensation. In that case, the prognosis starts to deteriorate, and the survival rate falls.
There is also something known as Model For End-Stage Liver Disease, or MELD. This is a medical evaluation that results in a score, and depending on the result, doctors would determine if the patient needs liver transplantation. MELD uses creatinine, bilirubin, and a blood clotting test known as International Normalized Ratio. By joining these measurements, we can understand the severity of liver disease and detect end-stage damage more accurately. In most cases, a MELD score of 15 or higher suggests liver transplantation.
The above summarizes the most valuable indications for doctors, but there are also contraindications to consider. Even if you have a high MELD score, you might not be a suitable candidate if your age is higher than 70 years old. If you have metastatic liver cancer or a type of sepsis, liver transplantation is contraindicated. Cancer patients and survivors may not be candidates unless they have experienced no cancer relapse for many years. Other contraindications include coronary heart disease, pulmonary hypertension, and chronic obstructive pulmonary disease. Untreated alcohol abuse, morbid obesity, and patients that do not comply with medical recommendations can be considered relative contraindications to liver transplantation.
