Indications and Contraindications
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Patients with end stage liver disease who have failed standard medical and surgical therapy can be considered for liver transplantation. Signs and symptoms of end stage liver disease include jaundice, ascites, edema, variceal bleeding, low platelet count, fatigue, severe itching and worsening mental confusion. A number of acute and chronic diseases of the liver can result in end stage liver disease. Appropriate patient selection is paramount to the overall success of liver transplantation.
The University of Maryland Medical Center is one of the few programs in the country to perform liver transplants for the treatment of cholangiocarcinoma, a rare yet lethal cancer of the bile duct. This protocol has been approved by United National Organ Sharing and involves synchronized care from a multidisciplinary team of experts before, during and after the surgery. The University of Maryland Liver Center brings together experts in radiation oncology, medical oncology, interventional radiology, surgery, transplantation and hepatology to help treat patients with cholangiocarcinoma. Watch as Dr. Steve Hanish discusses UMMC's multidisciplinary approach to treating this disease.
Due to limited availability of donor livers, the procedure is contraindicated for patients who are unlikely to survive the procedure or receive long-term benefit. Patients are considered individually and their candidacy is assessed by a formal multidisciplinary evaluation process.
Common Indications for Liver Transplantation
Cholestatic Diseases: primary biliary cirrhosis, sclerosing cholangitis, secondary biliary cirrhosis, biliary atresia, cystic fibrosis
Chronic Hepatitis: hepatitis B, hepatitis C, hepatitis D, autoimmune chronic active hepatitis, cryptogenic cirrhosis, chronic drug toxicity or toxin exposure
Alcoholic Cirrhosis: Patients with alcoholic cirrhosis are considered for transplant if they meet current criteria for abstinence and rehabilitation.
- Abstinence of alcohol for six months.
- Ongoing participation in formal alcohol treatment program.
- Presence of adequate psychosocial supports as determined by social service and psychiatry consultants.
Patients who do not meet the above criteria at the time of referral will be given the opportunity to fulfill these criteria and undergo re-evaluation. Formal input from the psychiatry staff is required to assess the risk of return to alcohol use following liver transplantation.
- Metabolic Diseases: hemochromatosis, Wilson's disease, Alpha-1-antitrypsin deficiency, glycogen storage disease, tyrosinemia, familial amyloidotic polyneuropathy, other metabolic disorders treatable by liver replacement.
- Fulminant Acute Hepatic Necrosis: viral hepatitis, drug toxicity, toxin, Wilson's disease.
- Primary Hepatic Tumors: selected patients with hepatocellular carcinoma.
Special Expertise exists at University of Maryland for patients with:
- Fulminant Liver Failure
- Pulmonary Hypertension
- Portal and Mesenteric Venous Thrombosis
- Combined Transplants: kidney, pancreas, heart, lung
Contraindications to Liver Transplantation
While each patient is evaluated on an individual basis, the presence of one or more of the following will frequently preclude acceptance as a candidate for liver transplantation:
- HIV infection
- Active alcohol or substance abuse
- Systemic infections
- Life-limiting co-existing medical conditions: advanced heart, lung or neurologic conditions.
- Uncontrolled psychiatric disorder
- Inability to comply with pre- and post-transplant regimens
If you would like to make an appointment or talk to someone about our services, please call 410-328-5408 or 1-800-492-5538.