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  • Review Article
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The management of patients awaiting liver transplantation

Nature Reviews Gastroenterology & Hepatology volume 6, pages 648–659 (2009)Cite this article

Abstract

Since it was first performed in 1963, liver transplantation has become the only effective curative treatment in patients with liver failure. During the interval between being added to the waiting list and receiving a graft, the patient's condition may deteriorate as a result of disease progression or complications of the underlying liver disease. Both may result in death, removal from the waiting list because of futility of the procedure or, a worsened outcome following transplantation. The main aims during this period are to delay or prevent further deterioration in the patient's condition, to optimize their general medical health, to prevent, detect and treat any complications, and to offer treatment for specific conditions to improve the patient's overall outcome following liver transplantation.

Key Points

  • Waiting times for liver transplantation have increased, with the potential for disease progression and development of complications that can lead to removal from the waiting list or poor transplantation outcome

  • Prevention and management of the complications of end-stage liver disease can have a major impact on survival while waiting for liver transplantation and can increase the likelihood of undergoing transplantation

  • No robust evidence currently supports the use of neoadjuvant treatment for patients with hepatocellular carcinoma who are awaiting liver transplantation; however, the evidence suggests a benefit in selected patients

  • Antiviral therapy for chronic HCV infection before transplantation is associated with major complications and has reduced ability to clear the virus; however, in selected patients such treatment may be appropriate

  • Malnutrition is often overlooked as a complication of decompensated liver disease and its appropriate management will probably improve transplant outcome

  • Immunization before transplantation is a safe and effective way to reduce the incidence of preventable disease in high-risk patients after transplantation

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  1. Liver Unit, Queen Elizabeth Hospital, Birmingham, UK

    Ka-Kit Li & James Neuberger

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  1. Ka-Kit Li
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  2. James Neuberger
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Correspondence to James Neuberger.

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Li, KK., Neuberger, J. The management of patients awaiting liver transplantation. Nat Rev Gastroenterol Hepatol 6, 648–659 (2009). https://doi.org/10.1038/nrgastro.2009.163

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