Liver Transplantation Workup
- Author: Cosme Manzarbeitia, MD, FACS; Chief Editor: Julian Katz, MD more...
These are oriented toward determining the etiology of the disease, excluding HIV and other infections that may compromise a successful LT, and screening for the presence of tumors. The following laboratory tests are those most commonly ordered during a LT evaluation:
Liver function tests, total protein, albumin
Hepatitis screen (A, B, C)
Serologies - Cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), HIV
Arterial blood gases
Others (selective) - Carbohydrate antigen 19-9, cancer antigen 125
Evaluation and workup of prospective liver transplant recipients is as follows: The first step in the process of evaluating a potential candidate for LT is to determine the severity of the liver disease by clinical evaluation. In addition, an objective assessment, to include a comprehensive laboratory and radiological evaluation, is undertaken. The goal of this evaluation is 3-fold. First, it must establish a diagnosis of ESLD; second, it must exclude any absolute or relative contraindication to the proposed procedure; finally, it must assess the suitability and degree of illness of each patient to better allocate resources and optimize survival. The specific tests are outlined below. Once the results are received, specific consultations are sought to clear the patient for LT.
Mandatory consultations and clearances are as follows:
Psychiatrist and social worker consultations
Nephrologist, infectious diseases specialist, or dentist, as needed
One of the most important tools in this scheme is the Child-Turcotte-Pugh (CTP) scoring system, which is the system most widely used to grade the severity of liver disease. A patient is considered to be Child class A if he or she has fewer than 7 points, Child class B if he or she has 7-9 points, and Child class C if he or she has more than 10 points. For listing purposes, a patient must have at least 7 points (ie, be at least a Child class B), according to the minimal listing criteria consensus initially developed when the CTP score was the basis for organ allocation. Today, the CTP score is no longer the basis for organ allocation because this is now based on the Model for End-Stage Liver Disease (MELD) scoring system (see below; also see the MELD Score calculator).
Table. CTP Scoring System for Assessment of Severity of Disease (with respect to listing) (Open Table in a new window)
|Parameter||1 Point||2 Points||3 Points|
|Encephalopathy||None||Grade 1-2||Grade 3-4|
|Albumin, g/dL||>3.5||2.8-3.5||< 2.8|
|Bilirubin, mg/dL||< 2||2-3||> 3|
|International normalized ratio||< 1.7||1.7-2.3||>2.3|
Although a good effort to grade severity of disease, this classification does not reflect the severity of disease in persons with cholestatic diseases, such as primary biliary cirrhosis or primary sclerosing cholangitis (PSC), because the bilirubin limits are significantly higher for these conditions and the other manifestations are not present until very late in the disease. Thus, recent developments in the allocation system are investigating the MELD scoring system as the new basis for organ allocation.
Because of the many factors (ie, increasing number of deaths while on liver waiting list, inability to accurately categorize liver patients according to severity of liver disease using the partially subjective CTP classification, reports suggesting that waiting time correlates poorly with death while on the waiting list), a consensus opinion emerged that a revised allocation scheme was needed. The new liver allocation system implemented by the Organ Procurement Transplantation Network in February 2002 is based primarily on the severity of liver disease as assessed by the MELD and Pediatric End-Stage Liver Disease (PELD) survival models for all patients with chronic liver disease.
The MELD score is based on 3 biochemical variables, (1) serum bilirubin, (2) serum creatinine, and (3) international normalized ratio, and has been shown in retrospective and prospective studies to be highly predictive of 3-month mortality in patients with chronic liver disease. Similarly, the PELD model for pediatric patients (see below; also see the PELD Score calculator) was developed based on analyses of data from the Study of Pediatric Liver Transplantation database and has been shown retrospectively to be predictive of waiting list mortality in pediatric patients.
Model for End-Stage Liver Disease (MELD) scoring system:
Serum creatinine (Log e value) 0.957
- The maximum serum creatinine considered within the MELD score equation is 4.0 mg/dL (ie, for candidates with a serum creatinine >4.0 mg/dL, the serum creatinine level is set to 4.0 mg/dL).
- For candidates on dialysis, defined as having 2 or more dialysis treatments within the prior week, or candidates who have received 24 hours of continuous venovenous hemodialysis (CVVHD) within the prior week, the serum creatinine level is automatically be set to 4.0 mg/dL.
Serum bilirubin (Log e value) 0.378
International normalized ratio (INR) (Log e value) 1.120
Using these prognostic factors and regression coefficients, the UNetSM computerized system assigns a MELD score for each candidate based on the following calculation: MELD score = 0.957 x Log e (creatinine mg/dL) + 0. 378 x Log e (bilirubin mg/dL) + 1.120 x Log e (INR) + 0.643. Laboratory values < 1.0 are set to 1.0 for the purposes of the MELD score calculation. 
As an example, for a hypothetical candidate with cirrhosis caused by hepatitis C virus who has a serum creatinine concentration of 1.9 mg/dL, a serum bilirubin concentration of 4.2 mg/dL and an INR value of 1.2, the risk score would be calculated as follows: MELD score = (0.957 x Log e 1.9) + (0.378 x Log e 4.2) + (1.120 x Log e 1.2) + 0.643 = 2.0039.
The MELD score for each liver transplant candidate derived from this calculation is rounded to the tenth decimal place and then multiplied by 10. The hypothetical candidate in the example described above, therefore, would be assigned a risk score of 20. The MELD score is limited to a total of 40 points maximum.
Pediatric End-Stage Liver Disease (PELD) scoring system:
- Albumin (Loge value) -0.687
- Total bilirubin (Loge value) 0.480
- INR (Loge value) 1.857
- Growth failure (<-2 standard deviations [SD]) 0.667
- Age (< 1 y) 0.436 (Scores for candidates listed for liver transplantation before the candidate’s first birthday continue to include the value assigned for age (< 1 y) until the candidate reaches 24 months of age.)
- UNetSM assigns a PELD score for each candidate based on the following calculation: PELD score = 0.436 (age [< 1 y]) – 0.687 x Loge (albumin g/dL) + 0.480 x Loge (total bilirubin mg/dL) + 1.857 x Loge (INR) + 0.667 (growth failure [<-2 SD present]). Laboratory values < 1.0 are set to 1.0 for the purposes of the PELD score calculation. Growth failure is calculated based on age and gender using the current CDC growth chart.
- This is a much more precise method of ranking patients; therefore, patients most in need will be given the highest priority for donated livers, rather than simply allocating them to patients who have waited longer but who may be much more stable. The MELD policy replaced status 2A, 2B, and 3 with a continuous scale in February 2002 and is the current basis for liver allocation. Neither of these 2 scoring systems favors all patients, specifically patients with HCCs or exceptional cases.
Listing of candidates
Once the workup is complete, the patient and all workup results are presented to the candidate selection committee for a decision about the suitability for transplantation. This committee consists of transplantation surgeons, hepatologists, psychiatrists, social work representatives, cardiologists, pulmonologists, anesthesiologists, and, occasionally, the patient's primary care physician.
The following questions are posed to the committee before listing the patient for transplantation:
- Does the patient need LT as therapy for his or her disease?
- Have the indications and contraindications been properly assessed?
- What is the surgical risk?
- Is the patient's medical condition such that he or she will be able to tolerate the procedure and postoperative course?
- What are the chances of recurrent disease affecting graft and patient survival?
Volk et al found that the structure of committee meetings varies by center; however, the process is uniform and primarily involves inductive reasoning to review suitability for transplantation. In their observations, patients were excluded if they were too well, too sick, or too old or had nonhepatic comorbid conditions, substance abuse problems, or other psychosocial barriers.
See the list below:
Radiography (including chest radiography)
Angiogram/magnetic resonance angiography (selective)
Abdominal CT scanning
Stress thallium scanning, coronary angiography (as indicated)
In a study comparing the performance of imaging techniques for the detection of hepatocellular carcinoma in pre-liver transplant patients with cirrhosis, contrast-enhanced T1-weighted imaging (CE T1WI) outperformed diffusion-weighted MRI (DWI) with regard to per-patient sensitivity, negative predictive value and per-lesion sensitivity. The latter difference, however, was significant only for lesions between 1 and 2 cm, suggesting that DWI is a reasonable alternative to CE T1WI for detection of hepatocellular lesions above 2 cm.
See the list below:
Pulmonary function testing
See the list below:
During the workup of these patients, many tests may be ordered. Specific testing is performed on a case-by-case basis.
In the author's experience, most patients undergo both upper and lower GI endoscopies to evaluate for the presence of esophageal or gastric varices or to exclude GI malignancy.
Other common procedures may include paracentesis in patients with ascites, both for diagnostic purposes (eg, to exclude SBP) and for therapeutic intent (eg, alleviation of distention and hepatohydrothorax).
Many patients undergo a TIPS procedure while awaiting LT because of complications that warrant this approach. These conditions include esophageal or gastric variceal bleeding, refractory ascites, and hepatorenal syndrome (HRS).
Discussion of all the histopathological findings of the various diseases that lead to ESLD is beyond the scope of this article. In general, they can be classified into 3 broad categories: cirrhosis and fibroticlike states, acute hepatic necrosis, and malignancies.
United Network for Organ Sharing (UNOS) data. UNOS Web site. Available at http://www.unos.org/. Accessed: September 15, 2009.
United Network for Organ Sharing. MELD/PELD Calculator Documentation. Updated January 28, 2009. UNOS Web site. Available at http://www.unos.org/waitlist/includes_local/pdfs/meld_peld_calculator.pdf. Accessed: September 15, 2009.
Kanwal F, Dulai GS, Spiegel BM, Yee HF, Gralnek IM. A comparison of liver transplantation outcomes in the pre- vs. post-MELD eras. Aliment Pharmacol Ther. 2005 Jan 15. 21(2):169-77. [Medline].
Saab S, Han SH, Martin P. Liver transplantation. Selection, listing criteria, and preoperative management. Clin Liver Dis. 2000 Aug. 4(3):513-32. [Medline].
Centers for Disease Control and Prevention (CDC). Deaths: Preliminary data for 2006. National Vital Statistics Reports. June 11, 2008. 56(16):[Full Text].
Achord JL. Malnutrition and the role of nutritional support in alcoholic liver disease. Am J Gastroenterol. 1987 Jan. 82(1):1-7. [Medline].
Kim SJ, Kim DG, Park JH, Moon IS, Lee MD, Kim JI, et al. Clinical analysis of living donor liver transplantation in patients with portal vein thrombosis. Clin Transplant. 2011 Jan. 25(1):111-8. [Medline].
Volk ML, Biggins SW, Huang MA, Argo CK, Fontana RJ, Anspach RR. Decision making in liver transplant selection committees: a multicenter study. Ann Intern Med. 2011 Oct 18. 155(8):503-8. [Medline]. [Full Text].
Park MS, Kim S, Patel J, Hajdu CH, Do RK, Mannelli L, et al. Hepatocellular carcinoma: Detection with diffusion-weighted vs. contrast-enhanced MRI in pre-transplant patients. Hepatology. 2012 Feb 28. [Medline].
Broering DC, Wilms C, Bok P. Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg. 2004 Dec. 240(6):1013-24; discussions 1024-6.
Azoulay D, Bhangui P, Andreani P, Salloum C, Karam V, Hoti E, et al. Short- and long-term donor morbidity in right lobe living donor liver transplantation: 91 consecutive cases in a European Center. Am J Transplant. 2011 Jan. 11(1):101-10. [Medline].
Ikegami T, Shirabe K, Yoshizumi T, Aishima S, Taketomi YA, Soejima Y, et al. Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia. Am J Transplant. 2012 Apr 11. [Medline].
Warner P, Fusai G, Glantzounis GK, Sabin CA, Rolando N, Patch D, et al. Risk factors associated with early hepatic artery thrombosis after orthotopic liver transplantation - univariable and multivariable analysis. Transpl Int. 2011 Apr. 24(4):401-8. [Medline].
Afessa B, Gay PC, Plevak DJ, et al. Pulmonary complications of orthotopic liver transplantation. Mayo Clin Proc. 1993 May. 68(5):427-34. [Medline].
Slifkin M, Doron S, Snydman DR. Viral prophylaxis in organ transplant patients. Drugs. 2004. 64(24):2763-92. [Medline].
Aberg F, Mäkisalo H, Höckerstedt K, Isoniemi H. Infectious complications more than 1 year after liver transplantation: a 3-decade nationwide experience. Am J Transplant. 2011 Feb. 11(2):287-95. [Medline].
Rath PM, Saner F, Paul A, Lehmann N, Steinmann E, Buer J, et al. Multiplex PCR for rapid and improved diagnosis of bloodstream infections in liver transplant recipients. J Clin Microbiol. 2012 Jun. 50(6):2069-71. [Medline].
Munoz SJ, Rothstein KD, Reich D, Manzarbeitia C. Long-term care of the liver transplant recipient. Clin Liver Dis. 2000 Aug. 4(3):691-710. [Medline].
Martínez-Saldivar B, Prieto J, Berenguer M, de la Mata M, Pons JA, Serrano T, et al. Control of Blood Pressure in Liver Transplant Recipients. Transplantation. 2012 Mar 9. [Medline].
Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003 Sep 4. 349(10):931-40. [Medline].
Pawarode A, Fine DM, Thuluvath PJ. Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transpl. 2003 Jul. 9(7):741-7. [Medline].
Cohen AJ, Stegall MD, Rosen CB, Wiesner RH, Leung N, Kremers WK, et al. Chronic renal dysfunction late after liver transplantation. Liver Transpl. 2002 Oct. 8(10):916-21. [Medline].
Neau-Cransac M, Morel D, Bernard PH, et al. Renal failure after liver transplantation: outcome after calcineurin inhibitor withdrawal. Clin Transplant. 2002 Oct. 16(5):368-73. [Medline].
Lucey MR, Abdelmalek MF, Gagliardi R, et al. A comparison of tacrolimus and cyclosporine in liver transplantation: effects on renal function and cardiovascular risk status. Am J Transplant. 2005 May. 5(5):1111-9. [Medline].
Marik PE, Wood K, Starzl TE. The course of type 1 hepato-renal syndrome post liver transplantation. Nephrol Dial Transplant. 2006 Feb. 21(2):478-82. [Medline].
Terrault NA. Treatment of recurrent hepatitis C in liver transplant recipients. Clin Gastroenterol Hepatol. 2005 Oct. 3(10 Suppl 2):S125-31. [Medline].
Jacob M, Copley LP, Lewsey JD, et al. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland. Liver Transpl. 2004 Jul. 10(7):903-7. [Medline].
Beckebaum S, Cicinnati VR, Klein CG, et al. Impact of combined mycophenolate mofetil and low-dose calcineurin inhibitor therapy on renal function, cardiovascular risk factors, and graft function in liver transplant patients: preliminary results of an open prospective study. Transplant Proc. 2004 Nov. 36(9):2671-4. [Medline].
Kornberg A, Kupper B, Hommann M, Scheele J. Introduction of MMF in conjunction with stepwise reduction of calcineurin inhibitor in stable liver transplant patients with renal dysfunction. Int Immunopharmacol. 2005 Jan. 5(1):141-6. [Medline].
Raimondo ML, Dagher L, Papatheodoridis GV, et al. Long-term mycophenolate mofetil monotherapy in combination with calcineurin inhibitors for chronic renal dysfunction after liver transplantation. Transplantation. 2003 Jan 27. 75(2):186-90. [Medline].
Cantarovich M, Tzimas GN, Barkun J, Deschenes M, Alpert E, Tchervenkov J. Efficacy of mycophenolate mofetil combined with very low-dose cyclosporine microemulsion in long-term liver-transplant patients with renal dysfunction. Transplantation. 2003 Jul 15. 76(1):98-102. [Medline].
Yoshida EM, Marotta PJ, Greig PD, et al. Evaluation of renal function in liver transplant recipients receiving daclizumab (Zenapax), mycophenolate mofetil, and a delayed, low-dose tacrolimus regimen vs. a standard-dose tacrolimus and mycophenolate mofetil regimen: a multicenter randomized clinical trial. Liver Transpl. 2005 Sep. 11(9):1064-72. [Medline].
Herrero JI, Quiroga J, Sangro B, et al. Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil. Liver Transpl Surg. 1999 Sep. 5(5):414-20. [Medline].
Barkmann A, Nashan B, Schmidt HH, et al. Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil. Transplantation. 2000 May 15. 69(9):1886-90. [Medline].
Stewart SF, Hudson M, Talbot D, Manas D, Day CP. Mycophenolate mofetil monotherapy in liver transplantation. Lancet. 2001 Feb 24. 357(9256):609-10. [Medline].
Hirose R, Roberts JP, Quan D, et al. Experience with daclizumab in liver transplantation: renal transplant dosing without calcineurin inhibitors is insufficient to prevent acute rejection in liver transplantation. Transplantation. 2000 Jan 27. 69(2):307-11. [Medline].
Ziolkowski J, Paczek L, Senatorski G, et al. Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity. Transplant Proc. 2003 Sep. 35(6):2307-9. [Medline].
Nair S, Eason J, Loss G. Sirolimus monotherapy in nephrotoxicity due to calcineurin inhibitors in liver transplant recipients. Liver Transpl. 2003 Feb. 9(2):126-9. [Medline].
Bahirwani R, Shaked O, Bewtra M, Forde K, Reddy KR. Acute-on-Chronic Liver Failure Before Liver Transplantation: Impact on Posttransplant Outcomes. Transplantation. 2011 Oct 27. 92(8):952-7. [Medline].
Egawa H, Ueda Y, Ichida T, Teramukai S, Nakanuma Y, Onishi S, et al. Risk Factors for Recurrence of Primary Sclerosing Cholangitis after Living Donor Liver Transplantation in Japanese Registry. Am J Transplant. 2011 Mar. 11(3):518-527. [Medline].
Faure S, Herrero A, Jung B, Duny Y, Daures JP, Mura T, et al. Excessive alcohol consumption after liver transplantation impacts on long-term survival, whatever the primary indication. J Hepatol. 2012 Aug. 57(2):306-12. [Medline].
Yoo HY, Thuluvath PJ. Short-term postliver transplant survival after the introduction of MELD scores for organ allocation in the United States. Liver Int. 2005 Jun. 25(3):536-41. [Medline].
Bajaj JS, Saeian K. MELD score does not discriminate against patients with hepatic encephalopathy. Dig Dis Sci. 2005 Apr. 50(4):753-6. [Medline].
Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R. Results of the first year of the new liver allocation plan. Liver Transpl. 2004 Jan. 10(1):7-15. [Medline].
Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us?. Am J Transplant. 2006 Nov. 6(11):2651-9. [Medline].
Sun HY, Cacciarelli TV, Wagener MM, Singh N. Impact of duration of posttransplant renal replacement therapy on bacterial infections in liver transplant recipients. Liver Transpl. 2011 Jul 8. [Medline].
Onaca NN, Levy MF, Sanchez EQ, et al. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation. Liver Transpl. 2003 Feb. 9(2):117-23. [Medline].
Haydon GH, Hiltunen Y, Lucey MR, et al. Self-organizing maps can determine outcome and match recipients and donors at orthotopic liver transplantation. Transplantation. 2005 Jan 27. 79(2):213-8. [Medline].
Aberg F, Höckerstedt K, Roine RP, Sintonen H, Isoniemi H. Influence of liver-disease etiology on long-term quality of life and employment after liver transplantation. Clin Transplant. 2012 Mar 8. [Medline].
Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001 Jun. 33(6):1394-403. [Medline].
Decaens T, Roudot-Thoraval F, Hadni-Bresson S, et al. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients listed for HCC with a short waiting time. Liver Transpl. 2006 Dec. 12(12):1761-9. [Medline].
Lesurtel M, Mullhaupt B, Pestalozzi BC, Pfammatter T, Clavien PA. Transarterial chemoembolization as a bridge to liver transplantation for hepatocellular carcinoma: an evidence-based analysis. Am J Transplant. 2006 Nov. 6(11):2644-50. [Medline].
Kim do Y, Choi MS, Lee JH, et al. Milan criteria are useful predictors for favorable outcomes in hepatocellular carcinoma patients undergoing liver transplantation after transarterial chemoembolization. World J Gastroenterol. 2006 Nov 21. 12(43):6992-7. [Medline].
Millonig G, Graziadei IW, Freund MC, et al. Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma. Liver Transpl. 2007 Feb. 13(2):272-9. [Medline].
Ragni MV, Belle SH, Im K, Neff G, Roland M, Stock P, et al. Survival of human immunodeficiency virus-infected liver transplant recipients. J Infect Dis. 2003 Nov 15. 188(10):1412-20. [Medline].
Stock PG, Roland ME, Carlson L, et al. Kidney and liver transplantation in human immunodeficiency virus-infected patients: a pilot safety and efficacy study. Transplantation. 2003 Jul 27. 76(2):370-5. [Medline].
HIV positive and HIV negative patients have similar survival rates following liver transplant. Presented April 24, 2009 at the Annual Meeting of the European Association for the Study of the Liver. [Full Text].
Roland ME, Barin B, Carlson L, Frassetto LA, Terrault NA, Hirose R. HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes. Am J Transplant. 2008 Feb. 8(2):355-65. [Medline].
de Vera ME, Dvorchik I, Tom K, et al. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. Am J Transplant. 2006 Dec. 6(12):2983-93. [Medline].
Duclos-Vallee JC, Feray C, Sebagh M, Teicher E, Roque-Afonso AM, Roche B. Survival and recurrence of hepatitis C after liver transplantation in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatology. 2008 Feb. 47(2):407-17. [Medline].
Andreu M, Sola R, Sitges-Serra A, et al. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterology. 1993 Apr. 104(4):1133-8. [Medline].
Arroyo V, Gines P, Gerbes AL, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology. 1996 Jan. 23(1):164-76. [Medline].
Badalamenti S, Graziani G, Salerno F, Ponticelli C. Hepatorenal syndrome. New perspectives in pathogenesis and treatment. Arch Intern Med. 1993 Sep 13. 153(17):1957-67. [Medline].
Bernard B, Lebrec D, Mathurin P, et al. Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis. J Hepatol. 1997 Feb. 26(2):312-24. [Medline].
Boker KH, Dalley G, Bahr MJ, et al. Long-term outcome of hepatitis C virus infection after liver transplantation. Hepatology. 1997 Jan. 25(1):203-10. [Medline].
Bourgeois N, Deviere J, Yeaton P, et al. Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation. Gastrointest Endosc. 1995 Dec. 42(6):527-34. [Medline].
Broelsch CE, Burdelski M, Rogiers X, et al. Living donor for liver transplantation. Hepatology. 1994 Jul. 20(1 Pt 2):49S-55S. [Medline].
Bronster DJ, Emre S, Mor E, et al. Neurologic complications of orthotopic liver transplantation. Mt Sinai J Med. 1994 Jan. 61(1):63-9. [Medline].
Bussutil RW, Klintmalm GB, eds. Transplantation of the Liver. Philadelphia, Pa: WB Saunders; 1996.
Bzeizi KI, Jalan R, Plevris JN, Hayes PC. Primary graft dysfunction after liver transplantation: from pathogenesis to prevention. Liver Transpl Surg. 1997 Mar. 3(2):137-48. [Medline].
Cakaloglu Y, Tredger JM, Devlin J, Williams R. Importance of cytochrome P-450IIIA activity in determining dosage and blood levels of FK 506 and cyclosporine in liver transplant recipients. Hepatology. 1994 Aug. 20(2):309-16. [Medline].
Canzanello VJ, Schwartz L, Taler SJ, et al. Evolution of cardiovascular risk after liver transplantation: a comparison of cyclosporine A and tacrolimus (FK506). Liver Transpl Surg. 1997 Jan. 3(1):1-9. [Medline].
Caplan A. Must I be my brother's keeper? Ethical issues in the use of living donors as sources of liver and other solid organs. Transplant Proc. 1993 Apr. 25(2):1997-2000. [Medline].
Castells L, Escartín A, Bilbao I, Len O, Allende H, Vargas V. Liver transplantation in HIV-HCV coinfected patients: a case-control study. Transplantation. 2007 Feb 15. 83(3):354-8. [Medline].
Centers for Disease Control and Prevention. National Vital Statistics Report. 2001. 49 (3):June 26.
Child CG, Turcotte JG. Surgery and portal hypertension. The Liver and Portal Hypertension. Philadelphia, Pa: WB Saunders; 1964.
Cooper GS, Bellamy P, Dawson NV, et al. A prognostic model for patients with end-stage liver disease. Gastroenterology. 1997 Oct. 113(4):1278-88. [Medline].
Cosimi AB, Cho SI, Delmonico FL, et al. A randomized clinical trial comparing OKT3 and steroids for treatment of hepatic allograft rejection. Transplantation. 1987 Jan. 43(1):91-5. [Medline].
D'Alessandro AM, Ploeg RJ, Knechtle SJ, Pirsch JD, Stegall MD, Hoffmann R, et al. Retransplantation of the liver--a seven-year experience. Transplantation. 1993 May. 55(5):1083-7. [Medline].
D'Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci. 1986 May. 31(5):468-75. [Medline].
D'Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology. 1995 Jul. 22(1):332-54. [Medline].
Darby JM, Stein K, Grenvik A, Stuart SA. Approach to management of the heartbeating 'brain dead' organ donor. JAMA. 1989 Apr 21. 261(15):2222-8. [Medline].
Ding YT, Xu QX, Qiu YD. Molecular adsorbent recycling system in treating patients with acute liver failure: a bridge to liver transplantation. Hepatobiliary Pancreat Dis Int. 2004 Nov. 3(4):508-10. [Medline].
Dodd GD 3rd, Memel DS, Zajko AB, et al. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology. 1994 Sep. 192(3):657-61. [Medline].
Dodson SF, Issa S, Bonham A. Liver transplantation for chronic viral hepatitis. Surg Clin North Am. 1999 Feb. 79(1):131-45. [Medline].
Dravid VS, Shapiro MJ, Needleman L, et al. Arterial abnormalities following orthotopic liver transplantation: arteriographic findings and correlation with Doppler sonographic findings. AJR Am J Roentgenol. 1994 Sep. 163(3):585-9. [Medline].
Emond JC, Whitington PF, Thistlethwaite JR, et al. Transplantation of two patients with one liver. Analysis of a preliminary experience with "split-liver" grafting. Ann Surg. 1990 Jul. 212(1):14-22. [Medline].
Farmer DG, Rosove MH, Shaked A, Busuttil RW. Current treatment modalities for hepatocellular carcinoma. Ann Surg. 1994 Mar. 219(3):236-47. [Medline].
Ferenci P, Herneth A, Steindl P. Newer approaches to therapy of hepatic encephalopathy. Semin Liver Dis. 1996 Aug. 16(3):329-38. [Medline].
Fingerote RJ, Bain VG. Fulminant hepatic failure. Am J Gastroenterol. 1993 Jul. 88(7):1000-10. [Medline].
Flye MW, ed. Principles of Organ Transplantation. Philadelphia, Pa: WB Saunders; 1989.
Fong TL, Akriviadis EA, Runyon BA, Reynolds TB. Polymorphonuclear cell count response and duration of antibiotic therapy in spontaneous bacterial peritonitis. Hepatology. 1989 Mar. 9(3):423-6. [Medline].
Freese DK, Snover DC, Sharp HL, et al. Chronic rejection after liver transplantation: a study of clinical, histopathological and immunological features. Hepatology. 1991 May. 13(5):882-91. [Medline].
Fung JJ, Eliasziw M, Todo S, et al. The Pittsburgh randomized trial of tacrolimus compared to cyclosporine for hepatic transplantation. J Am Coll Surg. 1996 Aug. 183(2):117-25. [Medline].
Fung JJ, Todo S, Jain A, et al. Conversion from cyclosporine to FK 506 in liver allograft recipients with cyclosporine-related complications. Transplant Proc. 1990 Feb. 22(1):6-12. [Medline].
Goldstein RM, Secrest CL, Klintmalm GB, et al. Problematic vascular reconstruction in liver transplantation. Part I. Arterial. Surgery. 1990 May. 107(5):540-3. [Medline].
Grazi GL, Mazziotti A, Sama C, et al. Reversal of primary liver graft non-function using prostaglandins. Hepatogastroenterology. 1991 Jun. 38(3):254-6. [Medline].
Greig PD, Woolf GM, Sinclair SB, et al. Treatment of primary liver graft nonfunction with prostaglandin E1. Transplantation. 1989 Sep. 48(3):447-53. [Medline].
Hemming AW, Greig PD, Cattral MS, et al. A microemulsion of cyclosporine without intravenous cyclosporine in liver transplantation. Transplantation. 1996 Dec 27. 62(12):1798-802. [Medline].
Herrero JI, Quiroga J, Sangro B, et al. Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil. Liver Transpl Surg. 1999 Sep. 5(5):414-20. [Medline].
Hillaire S, Labianca M, Borgonovo G, et al. Peritoneovenous shunting of intractable ascites in patients with cirrhosis: improving results and predictive factors of failure. Surgery. 1993 Apr. 113(4):373-9. [Medline].
Hoofnagle JH, Kresina T, Fuller RK, et al. Liver transplantation for alcoholic liver disease: executive statement and recommendations. Summary of a National Institutes of Health workshop held December 6-7, 1996, Bethesda, Maryland. Liver Transpl Surg. 1997 May. 3(3):347-50. [Medline].
Hughes RD, Williams R. Evaluation of extracorporeal bioartificial liver devices. Liver Transpl Surg. 1995 May. 1(3):200-6. [Medline].
Inadomi J, Sonnenberg A. Cost-analysis of prophylactic antibiotics in spontaneous bacterial peritonitis. Gastroenterology. 1997 Oct. 113(4):1289-94. [Medline].
Jurim O, Shackleton CR, McDiarmid SV, et al. Living-donor liver transplantation at UCLA. Am J Surg. 1995 May. 169(5):529-32. [Medline].
Jurim O, Shaked A, Kiai K, et al. Celiac compression syndrome and liver transplantation. Ann Surg. 1993 Jul. 218(1):10-2. [Medline].
Keeffe EB. Summary of guidelines on organ allocation and patient listing for liver transplantation. Liver Transpl Surg. 1998 Sep. 4(5 Suppl 1):S108-14. [Medline].
Kim WR, Wiesner RH, Therneau TM, et al. Optimal timing of liver transplantation for primary biliary cirrhosis. Hepatology. 1998 Jul. 28(1):33-8. [Medline].
Kirsch JP, Howard TK, Klintmalm GB, et al. Problematic vascular reconstruction in liver transplantation. Part II. Portovenous conduits. Surgery. 1990 May. 107(5):544-8. [Medline].
Kleber G, Sauerbruch T, Ansari H, Paumgartner G. Prediction of variceal hemorrhage in cirrhosis: a prospective follow-up study. Gastroenterology. 1991 May. 100(5 Pt 1):1332-7. [Medline].
Klein AS, Savader S, Burdick JF, et al. Reduction of morbidity and mortality from biliary complications after liver transplantation. Hepatology. 1991 Nov. 14(5):818-23. [Medline].
Klintmalm GB, Gonwa TA. Nephrotoxicity associated with cyclosporine and FK506. Liver Transpl Surg. 1995 Sep. 1(5 Suppl 1):11-9. [Medline].
Kondrup J, Muller MJ. Energy and protein requirements of patients with chronic liver disease. J Hepatol. 1997 Jul. 27(1):239-47. [Medline].
Krowka MJ. Hepatopulmonary syndrome: what are we learning from interventional radiology, liver transplantation, and other disorders?. Gastroenterology. 1995 Sep. 109(3):1009-13. [Medline].
Laghi A, Pavone P, Catalano C, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol. 1999 Jun. 172(6):1541-6. [Medline].
Lake JR. Changing indications for liver transplantation. Gastroenterol Clin North Am. 1993 Jun. 22(2):213-29. [Medline].
Langnas AN, Marujo W, Stratta RJ, et al. Vascular complications after orthotopic liver transplantation. Am J Surg. 1991 Jan. 161(1):76-82; discussion 82-3. [Medline].
Lemmer ER, Spearman CW, Krige JE, et al. The management of biliary complications following orthotopic liver transplantation. S Afr J Surg. 1997 May. 35(2):77-81. [Medline].
Lerut J, Tzakis AG, Bron K, et al. Complications of venous reconstruction in human orthotopic liver transplantation. Ann Surg. 1987 Apr. 205(4):404-14. [Medline].
Lidofsky SD, Bass NM, Prager MC, et al. Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure. Hepatology. 1992 Jul. 16(1):1-7. [Medline].
Linas SL, Schaefer JW, Moore EE, et al. Peritoneovenous shunt in the management of the hepatorenal syndrome. Kidney Int. 1986 Nov. 30(5):736-40. [Medline].
Lu Y, Wang B, Yu L. Lamivudine in prevention and treatment of recurrent HBV after liver transplantation. Hepatobiliary Pancreat Dis Int. 2004 Nov. 3(4):504-7. [Medline].
Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997 Nov. 3(6):628-37. [Medline].
Luxon BA. Liver transplantation. Who should be referred--and when?. Postgrad Med. 1997 Dec. 102(6):103-8, 113. [Medline].
Macedo G, Maia JC, Gomes A, et al. The role of transjugular liver biopsy in a liver transplant center. J Clin Gastroenterol. 1999 Sep. 29(2):155-7. [Medline].
Malloy PC, Marx MV. Diagnosis and management of biliary complications after orthotopic liver transplantation. LaBerge JM, Venbrux AC, eds. Biliary Interventions. San Francisco, Calif: Society of Cardiovascular & Interventional Radiology; 1995. 259-80.
Manzarbeitia C, Reich DJ, Rothstein KD, et al. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl. 2001 Feb. 7(2):93-9. [Medline].
Maraj R, Jacobs LE, Contreras R, et al. Is An Inducible Left Ventricular Outflow Tract Gradient During Dobutamine Echocardiography A Contraindication to Liver Transplant. Hepatology. 2000. 32(4):
Marcos A, Fisher RA, Ham JM, et al. Right lobe living donor liver transplantation. Transplantation. 1999 Sep 27. 68(6):798-803. [Medline].
Markmann JF, Markowitz JS, Yersiz H, et al. Long-term survival after retransplantation of the liver. Ann Surg. 1997 Oct. 226(4):408-18; discussion 418-20. [Medline].
Matsuzaki Y, Tanaka N, Osuga T, et al. Improvement of biliary enzyme levels and itching as a result of long- term administration of ursodeoxycholic acid in primary biliary cirrhosis. Am J Gastroenterol. 1990 Jan. 85(1):15-23. [Medline].
Mazariegos GV, Molmenti EP, Kramer DJ. Early complications after orthotopic liver transplantation. Surg Clin North Am. 1999 Feb. 79(1):109-29. [Medline].
Mazzaferro V, Esquivel CO, Makowka L, et al. Hepatic artery thrombosis after pediatric liver transplantation--a medical or surgical event?. Transplantation. 1989 Jun. 47(6):971-7. [Medline].
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14. 334(11):693-9. [Medline].
McDiarmid SV, Colonna JO 2nd, Shaked A, et al. A comparison of renal function in cyclosporine- and FK-506-treated patients after primary orthotopic liver transplantation. Transplantation. 1993 Oct. 56(4):847-53. [Medline].
McGory RW, Ishitani MB, Oliveira WM, et al. Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization. Transplantation. 1996 May 15. 61(9):1358-64. [Medline].
Miller CM, Mazzaferro V, Makowka L, et al. Rapid flush technique for donor hepatectomy: safety and efficacy of an improved method of liver recovery for transplantation. Transplant Proc. 1988. 20:948-50.
National Institutes of Health. National Institutes of Health Consensus Development Conference Statement: liver transplantation--June 20-23, 1983. Hepatology. 1984 Jan-Feb. 4(1 Suppl):107S-110S. [Medline].
Neff GW, Bonham A, Tzakis AG, et al. Orthotopic liver transplantation in patients with human immunodeficiency virus and end-stage liver disease. Liver Transpl. 2003 Mar. 9(3):239-47. [Medline].
Neff GW, Sherman KE, Eghtesad B. Review article: current status of liver transplantation in HIV-infected patients. Aliment Pharmacol Ther. 2004 Nov 15. 20(10):993-1000. [Medline].
Nghiem HV. Imaging of hepatic transplantation. Radiol Clin North Am. 1998 Mar. 36(2):429-43. [Medline].
No authors listed. Treatment of hepatic artery thrombosis after orthotopic liver transplantation. Asian J Surg. 2004 7. 27(3):218.
O'Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation. Arch Surg. 1995 Mar. 130(3):312-7. [Medline].
O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989 Aug. 97(2):439-45. [Medline].
Ormonde DG, de Boer WB, Kierath A, et al. Banff schema for grading liver allograft rejection: utility in clinical practice. Liver Transpl Surg. 1999 Jul. 5(4):261-8. [Medline].
Otte JB, de Ville de Goyet J, Sokal E. Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation. Ann Surg. 1990 Feb. 211(2):146-57. [Medline].
Pagliaro L, D'Amico G, Sorensen TI, et al. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med. 1992 Jul 1. 117(1):59-70. [Medline].
Patenaude YG, Dubois J, Sinsky AB, et al. Liver transplantation: review of the literature. Part 2: Vascular and biliary complications. Can Assoc Radiol J. 1997 Aug. 48(4):231-42. [Medline].
Patience C, Takeuchi Y, Weiss RA. Infection of human cells by an endogenous retrovirus of pigs. Nat Med. 1997 Mar. 3(3):282-6. [Medline].
Pauwels A, Mostefa-Kara N, Debenes B, et al. Systemic antibiotic prophylaxis after gastrointestinal hemorrhage in cirrhotic patients with a high risk of infection. Hepatology. 1996 Oct. 24(4):802-6. [Medline].
Paya CV, Hermans PE, Wiesner RH, et al. Cytomegalovirus hepatitis in liver transplantation: prospective analysis of 93 consecutive orthotopic liver transplantations. J Infect Dis. 1989 Nov. 160(5):752-8. [Medline].
Penn I. The effect of immunosuppression on pre-existing cancers. Transplantation. 1993 Apr. 55(4):742-7. [Medline].
Perrillo R, Rakela J, Martin P, et al. Long-term lamivudine therapy of patients with recurrent hepatitis B post liver transplantation. Hepatology. 1997. 26:177A.
Ploeg RJ, D'Alessandro AM, Knechtle SJ, et al. Risk factors for primary dysfunction after liver transplantation--a multivariate analysis. Transplantation. 1993 Apr. 55(4):807-13. [Medline].
Podesta A, Lopez P, Terg R, et al. Treatment of pruritus of primary biliary cirrhosis with rifampin. Dig Dis Sci. 1991 Feb. 36(2):216-20. [Medline].
Poles MA, Martin P. Routine endoscopy in liver transplant candidates: is it indicated?. Am J Gastroenterol. 1999 Apr. 94(4):871-2. [Medline].
Porayko MK, Kondo M, Steers JL. Liver transplantation: late complications of the biliary tract and their management. Semin Liver Dis. 1995 May. 15(2):139-55. [Medline].
Reich D, Rothstein K, Manzarbeitia C, Munoz S. Common medical diseases after liver transplantation. Semin Gastrointest Dis. 1998 Jul. 9(3):110-25. [Medline].
Reich D, Sharieff K, Behrend J, Manzarbeitia C. Venovenous bypass in liver transplantation. Graft - Organ and Cell Transplantation. 2000. 3:81-5.
Reich DJ, Munoz SJ, Rothstein KD, et al. Controlled non-heart-beating donor liver transplantation: a successful single center experience, with topic update. Transplantation. 2000 Oct 27. 70(8):1159-66. [Medline].
Reyes J, Iwatsuki S. Current management of portal hypertension with liver transplantation. Adv Surg. 1992. 25:189-208. [Medline].
Reyes J, Mazariegos GV. Pediatric transplantation. Surg Clin North Am. 1999 Feb. 79(1):163-89. [Medline].
Rosen HR, Shackleton CR, Martin P. Indications for and timing of liver transplantation. Med Clin North Am. 1996 Sep. 80(5):1069-102. [Medline].
Rubin R, Munoz SJ. Clinicopathologic features of late hepatic dysfunction in orthotopic liver transplants. Hum Pathol. 1993 Jun. 24(6):643-51. [Medline].
Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology. 1998 Jan. 27(1):264-72. [Medline].
Runyon BA, Antillon MR, Akriviadis EA, McHutchison JG. Bedside inoculation of blood culture bottles with ascitic fluid is superior to delayed inoculation in the detection of spontaneous bacterial peritonitis. J Clin Microbiol. 1990 Dec. 28(12):2811-2. [Medline].
Runyon BA, McHutchison JG, Antillon MR, et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology. 1991 Jun. 100(6):1737-42. [Medline].
Rustgi VK. Epstein-Barr viral infection and posttransplantation lymphoproliferative disorders. Liver Transpl Surg. 1995 Sep. 1(5 Suppl 1):100-8. [Medline].
Sale GE, Snover DC, Radio SJ. Transplantation pathology. Danjanou J, Linder F, eds. Anderson's Pathology. 10th ed. St. Louis: Mo: Mosby; 1996. 663.
Sanchez-Urdazpal L, Gores GJ, Ward EM, et al. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology. 1992 Jul. 16(1):49-53. [Medline].
Sanyal AJ. The management of the cirrhotic patient after transjugular intrahepatic portosystemic shunt. Semin Gastrointest Dis. 1997 Oct. 8(4):188-99. [Medline].
Sanyal AJ, Freedman AM, Luketic VA, et al. Transjugular intrahepatic portosystemic shunts compared with endoscopic sclerotherapy for the prevention of recurrent variceal hemorrhage. A randomized, controlled trial. Ann Intern Med. 1997 Jun 1. 126(11):849-57. [Medline].
Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med. 1999 Apr 1. 340(13):988-93. [Medline].
Schalm SW, van Buuren HR. Prevention of recurrent variceal bleeding: non-surgical procedures. Clin Gastroenterol. 1985 Jan. 14(1):209-32. [Medline].
Schmilovitz-Weiss H, Ben-Ari Z, Sikuler E. Lamivudine treatment for acute severe hepatitis B: a pilot study. Liver Int. 2004 Dec. 24(6):547-51. [Medline].
Schneider AW, Kalk JF, Klein CP. Effect of losartan, an angiotensin II receptor antagonist, on portal pressure in cirrhosis. Hepatology. 1999 Feb. 29(2):334-9. [Medline].
Shaked A, Busuttil RW. Liver transplantation in patients with portal vein thrombosis and central portacaval shunts. Ann Surg. 1991 Dec. 214(6):696-702. [Medline].
Sheiner PA, Schluger LK, Emre S, et al. Retransplantation for recurrent hepatitis C. Liver Transpl Surg. 1997 Mar. 3(2):130-6. [Medline].
Shiffman ML, Jeffers L, Hoofnagle JH, Tralka TS. The role of transjugular intrahepatic portosystemic shunt for treatment of portal hypertension and its complications: a conference sponsored by the National Digestive Diseases Advisory Board. Hepatology. 1995 Nov. 22(5):1591-7. [Medline].
Siegelman ES, Outwater EK. MR imaging techniques of the liver. Radiol Clin North Am. 1998 Mar. 36(2):263-86. [Medline].
Singh N. The current management of infectious diseases in the liver transplant recipient. Clin Liver Dis. 2000 Aug. 4(3):657-73, ix. [Medline].
Singh N, Gayowski T, Wagener MM, et al. Pulmonary infiltrates in liver transplant recipients in the intensive care unit. Transplantation. 1999 Apr 27. 67(8):1138-44. [Medline].
Snowden CP, Hughes T, Rose J, et al. Pulmonary edema in patients after liver transplantation. Liver Transpl. 2000 Jul. 6(4):466-70. [Medline].
Soifer B, Gelb AW. The multiple organ donor: identification and management. Ann Intern Med. 1989 May 15. 110(10):814-23. [Medline].
Somberg KA, Lake JR, Doherty MM, et al. The clinical course following transjugular intrahepatic portosystemic shunts (TIPS) in liver transplant candidates. Hepatology. 1993. 18:103A.
Stanley MM, Ochi S, Lee KK, et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites. N Engl J Med. 1989 Dec 14. 321(24):1632-8. [Medline].
Starzl TE, Miller CM, Rappaport FT. Algorithm and explantation: approach to the potential organ donor. Miscellaneous care problems. American College of Surgeons: Care of the Surgical Patient, Elective Care. New York, NY: Scientific American; 1990. Chap 10.
Stieber AC, Gordon RD, Todo S, et al. Liver transplantation in patients over sixty years of age. Transplantation. 1991 Jan. 51(1):271-3. [Medline].
Stratta RJ, Wood RP, Langnas AN, et al. Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation. Surgery. 1989 Oct. 106(4):675-83; discussion 683-4. [Medline].
Takaoka F, Brown MR, Paulsen AW, et al. Adult respiratory distress syndrome following orthotopic liver transplantation. Clin Transplant. 1989. 3:294-9.
Taler SJ, Textor SC, Canzanello VJ, et al. Role of steroid dose in hypertension early after liver transplantation with tacrolimus (FK506) and cyclosporine. Transplantation. 1996 Dec 15. 62(11):1588-92. [Medline].
Tanaka K, Uemoto S, Tokunaga Y, et al. Surgical techniques and innovations in living related liver transplantation. Ann Surg. 1993 Jan. 217(1):82-91. [Medline].
Taylor HM, Ros PR. Hepatic imaging. An overview. Radiol Clin North Am. 1998 Mar. 36(2):237-45. [Medline].
Teran JC, Imperiale TF, Mullen KD, et al. Primary prophylaxis of variceal bleeding in cirrhosis: a cost- effectiveness analysis. Gastroenterology. 1997 Feb. 112(2):473-82. [Medline].
Terra SG, Tsunoda SM. Opioid antagonists in the treatment of pruritus from cholestatic liver disease. Ann Pharmacother. 1998 Nov. 32(11):1228-30. [Medline].
Tian MG, Tso WK, Lo CM. Treatment of hepatic artery thrombosis after orthotopic liver transplantation. Asian J Surg. 2004 Jul. 27(3):213-7; discussion 218. [Medline].
Tito L, Rimola A, Gines P, et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology. 1988 Jan-Feb. 8(1):27-31. [Medline].
Todo S, Makowka L, Tzakis AG, et al. Hepatic artery in liver transplantation. Transplant Proc. 1987 Feb. 19(1 Pt 3):2406-11. [Medline].
Trevitt R, Whittaker C, Ball EA. Evaluation of potential transplant recipients and living donors. EDTNA ERCA J. 2000 Jan-Mar. 26(1):26-8. [Medline].
Tzakis A, Todo S, Stieber A, et al. Venous jump grafts for liver transplantation in patients with portal vein thrombosis. Transplantation. 1989 Sep. 48(3):530-1. [Medline].
Tzakis AG, Cooper MH, Dummer JS, et al. Transplantation in HIV+ patients. Transplantation. 1990 Feb. 49(2):354-8. [Medline].
Uriz J, Gines P, Cardenas A, et al. Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome. J Hepatol. 2000 Jul. 33(1):43-8. [Medline].
Wiesner RH. Liver transplantation for primary biliary cirrhosis and primary sclerosing cholangitis: predicting outcomes with natural history models. Mayo Clin Proc. 1998 Jun. 73(6):575-88. [Medline].
Winston DJ, Emmanouilides C, Busuttil RW. Infections in liver transplant recipients. Clin Infect Dis. 1995 Nov. 21(5):1077-89; quiz 1090-1. [Medline].
Wong T, Devlin J, Rolando N, et al. Clinical characteristics affecting the outcome of liver retransplantation. Transplantation. 1997 Sep 27. 64(6):878-82. [Medline].
Yang MD, Wu CC, Chen HC, et al. Biliary complications in long-term recipients of reduced-size liver transplants. Transplant Proc. 1996 Jun. 28(3):1680-1. [Medline].
Young JB. Clinical Trends in Transplant Survival. AST Lectures in Transplantation. Mt. Laurel, NJ: American Society of Transplantation; 2000.
Zajko AB, Sheng R, Bron K, et al. Percutaneous transluminal angioplasty of venous anastomotic stenoses complicating liver transplantation: intermediate-term results. J Vasc Interv Radiol. 1994 Jan-Feb. 5(1):121-6. [Medline].
|Parameter||1 Point||2 Points||3 Points|
|Encephalopathy||None||Grade 1-2||Grade 3-4|
|Albumin, g/dL||>3.5||2.8-3.5||< 2.8|
|Bilirubin, mg/dL||< 2||2-3||> 3|
|International normalized ratio||< 1.7||1.7-2.3||>2.3|