Liver Transplant Indications

A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. Liver failure can also be the end result of a long-term problem.

The following conditions may result in chronic liver failure:

  • Chronic hepatitis with cirrhosis.
  • Primary biliary cholangitis (previously called primary biliary cirrhosis, it isa rare condition where the immune system inappropriately attacks and destroys the bile ducts)
  • Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
  • Biliary atresia (a rare disease of the liver that affects newborns)
  • Alcoholism
  • Wilson’s disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
  • Hemochromatosis (a common inherited disease where the body has too much iron)
  • Alpha-1 antitrypsin deficiency (an abnormal buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)

Liver transplantation is potentially applicable to any acute or chronic condition resulting in irreversible liver dysfunction, provided that the recipient does not have other conditions that will preclude a successful transplant. Uncontrolled metastatic cancer outside liver, active drug or alcohol abuse and active septic infections are absolute contraindications. While HIV infection was once considered an absolute contraindication, this has been changing recently. Advanced age and serious heart, lung, or other disease may also prevent transplantation (relative contraindications). Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver, or cirrhosis of the liver. Some centers use the Milan criteria to select patients with liver cancers for liver transplantation.