Journal Article

Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation

Coilly, Audrey, Samuel, Didier

2018

Overview

Background The results of liver transplantation are excellent, with survival rates of over 90 and 80% at 1 and 5 years, respectively. The success of liver transplantation has led to an increase in the indications for liver transplantation. Generally, priorities are given to cirrhotic patients with a high Model for End-Stage Liver Disease (MELD) score on the principle of the sickest first and to patients with hepatocellular carcinoma (HCC) on the principle of priority points according to the size and number of nodules of HCC. These criteria can lead to a ‘competition’ on the waiting list between the above patients and those who are cirrhotic and have an intermediate MELD score or with life-threatening liver diseases not well described by the MELD score. For this latter group of patients, ‘MELD exception’ points can be arbitrarily given. Discussion The management of patients on the waiting list is of prime importance to avoid death and drop out from the waiting list as well as to improve post-transplant survival rates. For the more severe cases who may swiftly access liver transplantation, it is essential to rapidly determine whether liver transplantation is indeed indicated, and to organise a fast workup ahead of this. It is also essential to identify the ideal timing for liver transplantation in order to minimise mortality rates. For patients with HCC, a bridge therapy is frequently required to avoid progression of HCC and to maintain patients within the criteria of liver transplantation as well as to reduce the risk of post-transplant recurrence of HCC. For patients with cirrhosis and intermediate MELD score, waiting time can exceed 1 year; therefore, regular follow-up and management are essential to maintain the patient alive on the waiting list and to achieve a good survival after liver transplantation. Conclusion There is a diversity of patients on the waiting list for transplantation and equity should be preserved between those with cirrhosis of high and intermediate severity and those with HCC. The management of patients on the waiting list is an essential component of the success of liver transplantation.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute on chronic liver failure / Analysis / Biomedicine / Care and treatment / Cirrhosis / Female / Gastroenterology / Hepatitis / Hepatocellular carcinoma / Hospital waiting lists / Human health and pathology / Humans / Hépatology and Gastroenterology / Life Sciences / Liver / Liver cancer / Liver cirrhosis / Liver diseases / Liver Diseases - therapy / Liver transplantation / Liver Transplantation - methods / Liver Transplantation - mortality / Liver transplants / Male / Managing liver disease / Medicine / Medicine & Public Health / Meld score / Middle Aged / Mortality / Opinion / Patients / Success / Surgery / Survival Rate / Transplantation / Transplants & implants / Viral hepatitis / Waiting Lists