Editing Liver transplantation (section)

== Contraindications ==
Although liver transplantation is the most effective treatment for many forms of end-stage liver disease, the tremendous limitation in allograft (donor) availability and widely variable post-surgical outcomes make case selection critically important. Assessment of a person's transplant eligibility is made by a multi-disciplinary team that includes surgeons, medical doctors, psychologists and other providers.{{citation needed|date=March 2022}}

The first step in evaluation is to determine whether the patient has irreversible liver-based disease which will be cured by getting a new liver.<ref name="Varma">{{cite journal|last1=Varma|first1=V|last2=Mehta|first2=N|last3=Kumaran|first3=V|title=Indications and contraindications for liver transplantation.|journal=International Journal of Hepatology|date=2011|volume=2011|pages=121862|doi=10.4061/2011/121862|pmid=22007310|pmc=3189562|doi-access=free}}</ref> Thus, those with diseases which are primarily based outside the liver or have spread beyond the liver are generally considered poor candidates. Some examples include:
* someone with advanced liver cancer, with known/likely spread beyond the liver. Or those with cancer of any type, if the cancer cannot be treated successfully without rendering them unsuitable for transplant (other than skin cancers).<ref name="Lucey 2023" />
* active illicit substance use<ref name="Lucey 2023" />
* anatomic abnormalities that prevent liver transplantation<ref name="Lucey 2023" />
* severe heart/lung disease, whether it is primary heart/lung disease, or brought on by the liver disease (unless the team thinks they can still proceed)<ref name="Lucey 2023" />
* [[HIV/AIDS]], especially if it is not well-managed (some persons with HIV/AIDS that have very low or undetectable viral loads could still be eligible)<ref name="Lucey 2023" />

Importantly, many contraindications to liver transplantation are considered reversible; a person initially deemed "transplant-ineligible" may later become a favorable candidate if the circumstances change.<ref name="Varma" /><ref>{{cite journal|last1=Ho|first1=Cheng-Maw|last2=Lee|first2=Po-Huang|last3=Cheng|first3=Wing Tung|last4=Hu|first4=Rey-Heng|last5=Wu|first5=Yao-Ming|last6=Ho|first6=Ming-Chih|title=Succinct guide to liver transplantation for medical students|journal=Annals of Medicine and Surgery|date=December 2016|volume=12|pages=47–53|doi=10.1016/j.amsu.2016.11.004|pmid=27895907|pmc=5121144}}</ref> Some examples include:
* partial treatment of liver cancer, such that risk of spread beyond liver is decreased (for those with primary liver cancer or secondary spread to the liver, the medical team will likely rely heavily on the opinion of the patient's primary provider, the oncologist, and the radiologist)
* cessation of substance use (time period of abstinence is variable)
* improvement in heart function, e.g. by [[percutaneous coronary intervention]] or [[Coronary artery bypass surgery|bypass surgery]]
* treated HIV infection (''see [[#Special populations|Special populations]]'')

Other conditions, including hemodynamic instability requiring [[vasopressor]] support, large liver cancers or those with invasion to blood vessels, intrahepatic [[cholangiocarcinoma]], [[frailty syndrome|frailty]], fulminant liver failure with suspected brain injury, alcohol use disorder with recent alcohol consumption, cigarette smoking, inadequate social support, and nonadherence to medical management may disqualify someone from liver transplantation, however these cases are usually evaluated by the multi-disciplinary transplant team on an individual basis.<ref name="Lucey 2023" />