Timing of liver transplantation

Under the current environment of liver transplantation, there are several f actors to be considered in the timing of liver transplantation. These inclu de expected patient survival with and without liver transplantation patient 's morbidity and quality of the before and after liver transplantation and overall resource utilization. Statistical models have been developed for pa tients with chronic liver disease, particularly of cholestatic variety. By applying these models in patients being considered for liver transplantatio n, a window of optimal timing of liver transplantation may be defined in su ch way that the survival gain is maximized and perioperative mortality mini mized. Likewise, a number of pretransplant morbidity indicators such as Chi ld-Pugh score, UNOS status, and renal insufficiency have been found to have a profound influence on post-transplant morbidity, thus resource utilizati on. An in creasing number of investigators have measured and documented a d ramatic improvement in the quality of life of patients before and after liv er transplantation As the waiting time and uncertainty of the outcome of li ver transplantation increase, consideration of these factors may be useful for physicians evaluating transplant candidates to make best-informed decis ions in the selection of candidates and timing for liver transplantation.