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Liver transplantation for critically ill cirrhotic patients: Overview and pragmatic proposals
- Source :
- World Journal of Gastroenterology
- Publication Year :
- 2018
- Publisher :
- Baishideng Publishing Group Inc., 2018.
-
Abstract
- Liver transplantation for critically ill cirrhotic patients with acute deterioration of liver function associated with extrahepatic organ failures is controversial. While transplantation has been shown to be beneficial on an individual basis, the potentially poorer post-transplant outcome of these patients taken as a group can be held as an argument against allocating livers to them. Although this issue concerns only a minority of liver transplants, it calls into question the very heart of the allocation paradigms in place. Indeed, most allocation algorithms have been centered on prioritizing the sickest patients by using the model for end-stage liver disease score. This has led to allocating increasing numbers of livers to increasingly critically ill patients without setting objective or consensual limits on how sick patients can be when they receive an organ. Today, finding robust criteria to deem certain cirrhotic patients too sick to be transplanted seems urgent in order to ensure the fairness of our organ allocation protocols. This review starts by fleshing out the argument that finding such criteria is essential. It examines five types of difficulties that have hindered the progress of recent literature on this issue and identifies various strategies that could be followed to move forward on this topic, taking into account the recent discussion on acute on chronic liver failure. We move on to review the literature along four axes that could guide clinicians in their decision-making process regarding transplantation of critically ill cirrhotic patients.
- Subjects :
- Liver Cirrhosis
medicine.medical_specialty
Tissue and Organ Procurement
Cirrhosis
Critical Illness
medicine.medical_treatment
030230 surgery
Liver transplantation
Risk Assessment
Severity of Illness Index
Resource Allocation
End Stage Liver Disease
03 medical and health sciences
Liver disease
0302 clinical medicine
Argument
Sepsis
Acute on chronic liver failure
medicine
Organ failure
Humans
Intensive care medicine
Critically ill
business.industry
Patient Selection
Gastroenterology
Ethical
Minireviews
General Medicine
Prognosis
medicine.disease
Critical
Transplantation
Treatment Outcome
Practice Guidelines as Topic
030211 gastroenterology & hepatology
Liver function
Intensive
Intubation
business
Subjects
Details
- ISSN :
- 10079327
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- World Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....111d7fa2873622db90bc9f51307867df