The American Association for the Study of Liver Diseases (AASLD) and the American Society of Transplantation (AST) published practice guidelines in 2013 for the evaluation for liver transplantation in adults (Martin et al., 2014). US guidelines for the evaluation of paediatric patients for liver transplantation were published in 2014 (Squires et al., 2014).
Acute kidney injury (AKI) is associated with high mortality in the perioperative period following liver transplantation. The Liver Intensive Care Group of Europe recently published a position paper for AKI in liver transplant candidates. They noted that perioperative risk factors for AKI were difficult to control, emphasising a focus on intra-operative haemodynamics and avoidance of nephrotoxic drugs. They identified a requirement for randomised trials to explore the benefit of early renal replacement therapy, with a potential role for biomarkers able to demonstrate kidney injury earlier (Angeli et al., 2017).
Presently only patients with hepatocellular carcinoma (HCC) who are within the Milan Criteria can be listed for solid organ transplantation. This is based on a study by Mazaferro et al., the Milan Criteria includes patients with a single tumour ≤ 5 cm in diameter, or no more than three tumours sized ≤ 3 cm (Mazzaferro et al., 1996). The Milan criteria were adopted by the United Network for Organ Sharing (UNOS) and verified by multiple centres worldwide. Alternative criteria for HCC patient selection based on tumour size and nodule number (the UCSF criteria) have since been proposed and successfully applied by different centres worldwide. These were recently reviewed (Xu et al., 2016).
Alternativ über ... anmelden