Contraindications to liver transplantation
Last reviewed: 23.04.2024
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Absolute contraindications for liver transplantation
Diseases of the heart and lungs in the stage of decompensation, active infection, metastasizing malignant tumor, AIDS and severe brain damage are absolute contraindications to liver transplantation.
Transplantation should not be performed in patients who can not assess the significance of the operation and cope with the physical and psychological burden with which it is associated.
[Relative contraindications to liver transplantation (higher risk of surgery)
The group of high risk includes patients who, due to far-reaching liver damage, require intensive care and especially in the artificial ventilation of the lungs.
Particularly good liver transplantation results are observed in children, but it is technically more difficult to perform it in children under 2 years old. Elderly age as such is not an absolute contraindication to surgery; a greater value in the consideration of indications for liver transplantation is not a passport but a biological age; it is necessary to take into account the general condition of the patient. However, liver transplantation is usually performed in patients no older than 60 years.
According to a few studies, liver transplantation from a female donor to a male recipient is accompanied by less favorable results, but more evidence is needed to confirm this fact.
The operation is associated with a greater risk if the body weight of the patient exceeds 100 kg.
Absolute and relative contraindications for liver transplantation
Absolute
- Psychological, physical and social insolvency of the patient
- Active infections
- Metastases of a malignant tumor
- Cholangiocarcinoma
- AIDS
- Decompensated cardiopulmonary disease
Relative
- Age over 60 or under 2 years
- Performed earlier portocaval shunting
- Previous surgical intervention on the liver and biliary tract
- Thrombosis of the portal vein
- Repeated transplantation
- Multiple organ transplantation
- Obesity
- The level of creatinine is more than 0.176 mmol / l (2 mg%)
- Transplantation from CMV-positive donor to CMV-negative recipient
- A far gone liver injury
- Repeated transplantation or multiple organ transplantation is associated with greater risk.
The trans-implantation level of serum creatinine exceeding 2 mg% is the most accurate prognostic risk factor for post-transplant mortality.
Liver transplantation from a CMV-positive donor to a CMV-negative recipient is associated with greater risk.
Thrombosis of the portal vein makes transplantation difficult and reduces survival. Nevertheless, the operation is usually possible. In such patients, anastomosis is formed between the portal vein of the donor and the site of the fusion of the superior mesenteric and splenic veins of the recipient, or a donor venous graft is used.
Prior to transplantation, portocaval shunting complicates the operation, so it is advisable to resort to distal splenorenal shunting. The optimal intervention for bleeding from varicose veins is a transgular intrahepatic portosystemic shunt by means of stents, which does not create technical difficulties for subsequent transplantation.
Retransplantation is fraught with great technical difficulties. Previous surgical procedures on the upper floor of the abdominal cavity can make liver transplant technically impossible.