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Contraindications to liver transplantation
Last reviewed: 04.07.2025
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Absolute contraindications to liver transplantation
Decompensated heart and lung diseases, active infection, metastatic malignant tumor, AIDS and severe brain damage are absolute contraindications to liver transplantation.
Transplantation should not be performed in patients who are unable to appreciate the significance of the operation and cope with the physical and psychological stress associated with it.
[ Relative contraindications to liver transplantation (higher risk of surgery)
The high-risk group includes patients who, due to advanced liver damage, require intensive care and especially artificial ventilation.
Particularly good results of liver transplantation are noted in children, however, its implementation in children under 2 years of age is technically more difficult. Old age as such is not an absolute contraindication to surgery; more important when considering indications for liver transplantation is not the passport age, but the biological age; it is necessary to take into account the general condition of the patient. Nevertheless, liver transplantation is usually performed on patients under 60 years of age.
According to a few studies, liver transplantation from a female donor to a male recipient is associated with less favorable outcomes, but more observations are needed to confirm this fact.
The operation is associated with a high risk if the patient's body weight exceeds 100 kg.
Absolute and relative contraindications to liver transplantation
Absolute
- Psychological, physical and social incapacity of the patient
- Active infections
- Metastasis of a malignant tumor
- Cholangiocarcinoma
- AIDS
- Decompensated cardiopulmonary disease
Relative
- Age over 60 years or under 2 years
- Previously performed portocaval shunting
- Previous surgical intervention on the liver and bile ducts
- Portal vein thrombosis
- Re-transplantation
- Multiple organ transplantation
- Obesity
- Creatinine level greater than 0.176 mmol/L (2 mg%)
- Transplantation from a CMV-positive donor to a CMV-negative recipient
- Advanced liver disease
- Repeat transplantation or multiple organ transplantation carries greater risk.
Pretransplant serum creatinine levels greater than 2 mg% are the most accurate predictor of posttransplant mortality risk.
Liver transplantation from a CMV-positive donor to a CMV-negative recipient is associated with high risk.
Portal vein thrombosis complicates transplantation and reduces survival. However, surgery is usually possible. In such patients, an anastomosis is formed between the donor portal vein and the confluence of the superior mesenteric and splenic veins of the recipient, or a donor vein graft is used.
Pre-transplant portocaval shunting complicates the operation, so it is advisable to resort to distal splenorenal shunting. The optimal intervention for variceal bleeding is transjugular intrahepatic portosystemic shunting with stents, which does not create technical difficulties for subsequent transplantation.
Retransplantation is associated with major technical difficulties. Previous surgical interventions on the upper abdominal cavity may make liver transplantation technically impossible.