There are several considerations when referring a patient
for a liver transplant at Vanderbilt. See the information on contraindications, on the left. 

Pre-Liver Transplant Evaluation Protocol

All patients referred for Liver Transplant Evaluation will be reviewed by the transplant nurse coordinator. Following are the CRITERIA for the selection of potential liver transplantation candidates:

• Presence of end-stage disease with objective evidence of advanced physical incapacitation causing deterioration of the quality of life to an unacceptable level due to documented, isolated liver disease

• A limited life expectancy due to liver dysfunction

• Previous medical therapy has been optimized and no other therapy other than transplantation offers realistic expectation of functional improvement and extension of life

• Expected compliance with medical regimes

• Adequate psychosocial support system to aid the patient prior to and during the surgery and to promoted adherence to required post-transplant treatment regimes

• Acceptable surgical risks

Specific manifestations include:

• Malnutrition with progressive protein-calorie deficiency; Wasting and fatigue (Albumin <3.1)

• Uncorrectable coagulopathy (INR>1.5, Fibrinogen <150 mg/dl)

• Recurrent and uncontrollable hepatic encephalopathy

• Refractory ascites

• Spontaneous bacterial peritonitis

• Development of hepatorenal syndrome

• Development of fulminant hepatic failure

• Refractory, life-threatening variceal hemorrhage

• Severe progressive metabolic bone disease, especially with spontaneous fractures

• Recurrent episodes of biliary sepsis
  
   
• <5 cm but unresectable primary hepatic tumors confined to the liver