[Liver transplantation. Selection criteria and risk evaluation]

Area of Science:

• Hepatology
• Transplantation Surgery
• Cardiology

Background:

• Liver transplantation is increasingly common in North America and Western Europe.
• Organ availability is a major challenge, necessitating careful patient selection.
• Optimizing transplant outcomes requires precise patient evaluation and risk factor assessment.

Purpose of the Study:

• To emphasize the critical importance of accurate patient evaluation in liver transplantation.
• To highlight key risk factors and conditions that influence transplant success.
• To guide the selection of suitable candidates for liver transplant.

Main Methods:

• Standardized medical criteria for end-stage liver disease indication.
• Systematic search for patient risk factors.
• Evaluation of hemodynamic stress tolerance during inferior vena cava clamping.
• Assessment of comorbidities such as coronary disease, lung hypertension, hepatopulmonary syndrome, and diabetes.

Main Results:

• Patient selection and timing are paramount due to organ scarcity.
• Hemodynamic stress tolerance during vena cava clamping is a critical evaluation point.
• Lung hypertension, hepatopulmonary syndrome, and diabetes require careful consideration.
• Diabetes is not an absolute contraindication unless severe vascular, cardiac, or renal complications are present.

Conclusions:

• Accurate patient evaluation is as vital as surgical procedures and immunosuppression for liver transplant success.
• Comprehensive assessment of cardiovascular status, portal hypertension complications, and diabetes is essential.
• Rigorous patient selection based on identified risk factors maximizes the chances of successful liver transplantation.