Defining the threshold for too sick for transplant

Current Opinion in Organ Transplantation
Jennifer C Lai

Abstract

The most difficult, and perhaps, most important decision that a clinician makes for a patient on the liver transplant wait-list is when 'not' to proceed with liver transplant. Although an individual may be suitable for transplant surgery at listing, he/she may become too sick while waiting. This article reviews four specific conditions that commonly arise on the wait-list that may render a candidate too sick for transplant: advancing age, sarcopenia, acute on chronic liver failure, and nonliver-related medical comorbidities. Each condition, per se, is often not a criterion for delisting; the challenge arises when conditions exist in combination--how does one 'sum' up these conditions to quantify risk? Physical frailty, conceptually, represents the conditions in a candidate that are unlikely to reverse after liver function returns, or will take so long to reverse that the patient will be highly vulnerable to postoperative complications. Pretransplant assessments of physical frailty, which are objective, easily administered, and repeated in the clinical setting, enable us to measure the extent to which these factors, in isolation or combination, will reduce both quantity and quality of life after liver transplant. In this article...Continue Reading

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Citations

Feb 19, 2016·Current Opinion in Organ Transplantation·Norah A Terrault
Dec 2, 2017·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Giuseppe CullaroJennifer C Lai
Aug 2, 2017·Clinical Transplantation·Michael N TerjimanianKenneth J Woodside
Jun 24, 2018·Liver International : Official Journal of the International Association for the Study of the Liver·Robyn LaubeKen Liu
May 8, 2018·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Chiara MazzarelliMary D Cannon
Mar 30, 2019·Current Opinion in Gastroenterology·Mina O Rakoski, Michael L Volk
Nov 12, 2019·Alimentary Pharmacology & Therapeutics·Matthew J ArmstrongAlice Freer
Dec 1, 2016·Clinical Liver Disease·Jennifer C Lai
Nov 23, 2020·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Alyson KaplanRussell Rosenblatt
Nov 21, 2020·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Stephan C BischoffMathias Plauth
Jul 28, 2021·The American Journal of Gastroenterology·Fei-Pi LinAndrés Duarte-Rojo

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