Which of the following patients would be a candidate for a liver transplant?

a. A 48-year-old man with end-stage liver disease secondary to non-A, non-B hepatitis

b. A 35-year-old man with both primary sclerosing cholangitis and ulcerative colitis and end-stage liver disease

c. A 22-year-old woman with fulminant hepatic failure secondary to acetaminophen overdose d

. A 4-year-old child with congenital biliary atresia having failed a previous Kasai procedure

e. A 48-year-old patient with alcoholic cirrhosis and a 2.5 cm central unresectable hepatoma

In the absence of contraindications, virtually any disease resulting in liver failure is amenable to liver transplantation. Primary sclerosing cholangitis is a common indication for transplantation since there is no other effective treatment. The common association with inflammatory bowel disease can somewhat complicate the timing of the procedure, however, in general hepatic transplantation does not affect the outcome of the ulcerative colitis. Non-A, non-B hepatitis is the most common form of hepatitis leading to liver transplantation. Recurrence of viral hepatitis in the transplanted liver occurs, but usually follows an indolent course. Biliary atresia is by far the most common indication for hepatic transplantation in pediatric patients. Recommended treatment includes creation of a portoenterostomy (Kasai procedure), if this can be done before three months of age. After this point, success rates diminish markedly. Patients without a satisfactory course, multiple revisions of the portoenterostomy should be avoided to facilitate subsequent transplantation. The most common cause of fulminant hepatic failure are non-A, non-B hepatitis, hepatitis B, and various drug toxicities. In the latter group, acetaminophen toxicity is particularly prominent. Primary hepatic malignancy, most often hepatoma, is sometimes an indication for transplantation but the results are usually worse than in other disease states because of recurrent disease. Transplantation is justified in the occasional case in which the tumor is central but relatively small, if the patient is otherwise healthy, and there is no evidence of extrahepatic disease after exhaustive evaluation.