Latin American association for the study of the liver (ALEH) guidance on preoperative care in liver transplantation: referral criteria, patient assessment, and waiting list management
Year: 2025
Type: article
Abstract: ABSTRACT Liver transplantation (LT) is the standard of care therapy for patients with decompensated cirrhosis, early-stage hepatocellular carcinoma, acute liver failure, and other expanding indications. Latin America is a highly heterogeneous region characterized by an uneven distribution of socio-economic conditions and irregular access to health resources, and consequently LT activity varies across it. This current guidance of preoperative care in LT represents a collaborative effort to assess and standardize preoperative evaluation of liver transplant candidates in Latin America. It is the first position paper of the special interest group on LT of the Latin American Association for the Study of the Liver (ALEH), which draws evidence-based comprehensive recommendations regarding who to refer, the LT assessment and how to manage the patient on the waiting list, taking into consideration their applicability in Latin America. - Decompensation (variceal bleeding, hepatic encephalopathy, or ascites) - MELD score ≥ 15 - Hepatopulmonary syndrome or portopulmonary hypertension - Within transplant criteria (e.g., Milan or expanded criteria) - Within transplant criteria (e.g., King College or other) - Cystic fibrosis with concomitant lung and liver disease - Primary hyperoxaluria type I with significant renal insufficiency - Familial amyloid polyneuropathy - Persistent and intractable pruritus - Recurrent cholangitis - With severe complications, symptoms, or malignancy potential (e.g., adenomatosis, hepatic polycystosis, regenerative nodular hyperplasia, Caroli's disease, hepatic lymphangiomatosis, others) - Fibrolamellar carcinoma - Epithelioid hemangioendothelioma - Without contraindications - Not responding to corticoids (or contraindicated) with favorable predictors for post-transplant sobriety - Within MILAN NETML - Very selected cases, ideally in the context of clinical trial - Very selected cases, ideally in the context of clinical trial - Early-stage, unresectable perihilar cholangiocarcinoma, preceded by neoadjuvant therapy - Active extrahepatic malignancy - Hepatocellular carcinoma metastatic or AFP > 1,000 - Perihilar Cholangiocarcinoma outside transplantability criterias= - Severe cardiopulmonary disease - Uncontrolled sepsis - Active drug abuse - Persistent non-compliance or lack of social support - Technical and/or anatomic barriers to liver transplantation - Irreversible brain injury (in acute liver failure) - ACLF: More than three organ failures according to the CLIF-C organ failure score and/or CLIF-C ACLF score >64
Source: Annals of Hepatology
Authors: Victoria Mainardi, Josefina Pages, Josemaría Menendez, Rodrigo Zapata, Luis Antonio Díaz, Sebastian Marciano, Fernando Cairo, Martin Padilla-Machaca, Laura Tenorio, Alvaro Urzua, Lucia Navarro, Nicolas Dominguez, Pablo Coste, Manuel Mendizabal, Jorge Martinez, Sergio Lopez, Adriana Varon, Alfeu de Medeiros Fleck, Jhon Abad Gonzalez, Juan Carlos Restrepo, Liana Codes, Paulo Lisboa Bittencourt, Norma Marlene Pérez Figueroa, Graciela Castro-Narro, Débora Raquel B. Terrabuio, Mário Guimarães Pessoa, Marcos Girala, Leonardo Lucca Schiavon, Edgard Aguilera, Kenia Valenzuela Aguilera, Marcia Samada, Solange Gerona, Alejandra Villamil
Institutions: Hospital Central de las Fuerzas Armadas, Hospital Universitario Austral, Universidad del Desarrollo, Clínica Alemana, Pontificia Universidad Católica de Chile, University of California San Diego, Hospital Italiano de Buenos Aires, Hospital El Cruce, EsSALUD, Hospital Nacional Edgardo Rebagliati Martins, Hospital Clínico de la Universidad de Chile, University of Chile, Institute of Cardiology, Santa Casa Hospital, Hospital de Especialidades Carlos Andrade Marín, Hospital Pablo Tobon Uribe, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hospital Médica Sur, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Universidad Nacional de Asunción, Universidade Federal de Santa Catarina
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W4411921851