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Liver transplantation: patient selection, organ allocation, and outcomes 

Liver transplantation: patient selection, organ allocation, and outcomes
Chapter:
Liver transplantation: patient selection, organ allocation, and outcomes
Author(s):

Vishal C. Patel

and John O’Grady

DOI:
10.1093/med/9780199651429.003.0020
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date: 22 August 2019

In liver transplantation, careful selection of appropriate recipients and timely allocation of well-matched grafts are essential. These aim both to optimize use of the limited supply of donor organs and to secure each recipient good long-term survival and quality of life. The indications for liver transplantation in both acute and chronic liver disease are now well established, and timing is critical in both referral to a transplant centre and the decision to list. The risks associated with disease recurrence, common comorbidities, surgical complexity, and psychosocial factors are key considerations in recipient selection, and some constitute relative or absolute contraindications to transplant. Retransplantation presents added risks, as does sustained renal impairment, for which simultaneous liver–kidney transplant is increasingly performed. Thus the need for comprehensive, multidisciplinary assessment is universally recognized. Organ allocation practices, on the other hand, are more dependent on regional social and ethical norms and vary significantly across the world.

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