Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Liver Transplantation 913

➣severe impairment of quality of life and CTP≥^7

severe or progressive hepatic encephalopathy

refractory ascites

recurrent portal hypertensive hemorrhage

progressive and incapacitating fatigue

➣indicators of poor 1-year survival

hepatorenal syndrome

recurrent spontaneous bacterial peritonitis

prothrombin time >5 seconds prolonged

serum bilirubin >5 mg/dL

serum albumin <2.5 gm/dL

■cholestatic liver disease

➣severe impairment of quality of life and CTP≥^7

intractable pruritus

recurrent biliary sepsis

metabolic bone disease with fractures

xanthomatous neuropathy

➣indicators of poor 1-year survival

serum bilirubin >10 mg/dL

Mayo risk score for primary biliary cirrhosis or primary scle-

rosing cholangitis predictive of <90% 1-year survival

■inborn errors of metabolism (OLT corrects nonhepatic manifesta-

tions)

Absolute Contraindications to OLT

■advanced cardiac disease

■advanced pulmonary disease

■multisystem organ failure

■HIV seropositivity

■extrahepatic malignancy

■hemangiosarcomas

■cholangiocarcinoma

■active alcoholism or substance abuse

■medical noncompliance with immunosuppressive protocol

■anatomic abnormalities precluding OLT surgery

Immunosuppressive Drugs and Side Effects

■corticosteroids

➣hypertension, hyperglycemia, poor wound healing osteoporo-

sis, cataracts, mental status changes, susceptibility to infection,

edema, hirsutism