Conditions Appropriate for Referral to TGH’s Liver Transplant Program
- Hepatocellular diseases – Cryptogenic disease, autoimmune hepatitis, viral hepatitis, chronic drug-induced disease, and other liver diseases that result in cirrhosis are all noted liver transplant conditions.
- Cholestatic diseases – Primary and secondary causes of cholestasis resulting in cirrhosis are appropriate conditions for a liver transplant. The most common primary diseases are primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), while secondary diseases include Byler’s syndrome, biliary atresia, secondary schlerosing cholangitis, and familial cholestatic disorders.
- Primary hepatic tumors – Individuals affected by this condition must not be candidates for surgical resection, and their tumors must be confined to their livers (with no vascular involvement and no metastases) in order to be eligible for a liver transplant. Individuals with hepatocellular carcinoma (HCC) will be evaluated for transplant if they meet Milan criteria. People with HCC who do not meet Milan criteria but are within University of California San Francisco (UCSF) criteria may be considered for a transplant if their alpha-fetoprotein levels are decreasing and they are responding to chemoembolization therapy.
- Inborn errors of metabolism – Some diseases in this category that are appropriate liver transplant conditions, such as Wilson’s disease, tyrosinemia, alpha-1-antitrypsin deficiency, and hemochromatosis, may have effects on extra hepatic tissue that results in increased mortality or morbidity. Even some diseases in this category that don’t result in overt liver damage, such as urea cycle defects, homozygous hyperlipoproteinemia, primary hyperoxaluria, and other conditions, can require a liver transplant because of the threat of irreversible cardiac, renal, and/or neurological damage. Furthermore, polycystic liver disease is among the liver transplant conditions that are considered if a person has massive intra-abdominal volumes that impair quality of life and/or compression of the gastrointestinal tract that impedes adequate oral nutrition.
- Vascular diseases of the liver – Individuals with Budd-Chiari syndrome and veno-occlusive disease will be considered for transplant if portal hypertension cannot be controlled.
- Fulminant liver failure – This condition is defined as the onset of hepatic encephalopathy within eight weeks of the first symptoms of liver disease and the absence of pre-existing liver disease. A transplant should be considered as an emergency procedure if medical treatment alone has a poor prognosis.
For more information about specific conditions appropriate for a liver transplant, or to get information about TGH’s selection and referral criteria as well as contraindications for a transplant, please call TGH’s Liver Transplant Program at 1-800-505-7769 (press 4 for the liver transplant program and ask for the referral coordinator), or call the coordinator directly at (813) 844-8686.