Indications and timing for liver transplantation in adults.

Introduction. - The shortage of cadaveric organ donors imposes a severe lim it to the number of liver transplantations. A selection is thus necessary a mong patients: should the sickest be selected or those who supposedly have the best chance to survive and recover? Optimizing the timing of transplant ation during the course of the disease (not too early, but not too late) is another issue. Current knowledge and key points. - Suitable candidates for transplantation are patients suffering from an irreversible, symptomatic liver disease. Th e goals of therapy are: firstly, to favorably modify the natural outcome of the disease: and secondly, in an acceptable risk taking manner. Major crit erias for indication in the most common liver diseases can be summerized as follows: a) for chronic parenchymal liver diseases, a Child-Pugh score of 9 or 10, or less if complications have already occurred is a mandatory and often sufficient criterion; b) for cholestatic liver diseases, a serum bili rubin level higher than 100-150 mu mol/L is generally required; c) apart fr om <<small>> hepatocellular carcinomas on cirrhotic parenchyma (less than t hree tumors of less than 5 cm in diameter), most cancers are considered con traindications, d) acute liver failure requires early referral to a liver t ransplant center for potential emergency indication. Future prospects and projects. - In an organ shortage situation which is li kely to perdue, early consultative contact between the patient and the live r transplant team will allow improvement in the access to transplantation p rocedure. (C) 1998 Elsevier. Paris.