Who is a candidate for liver transplantation?

If you have cirrhosis with at least some degree of decompensation, you may be a candidate for liver transplantation. To qualify as a candidate for a liver transplant, you must be healthy enough to undergo surgery, be reliable with medication and follow-up appointments, and have a support system at home to help you with your posttransplant program.

Some problems may disqualify you from receiving a liver transplant:

• Alcohol or other substance abuse within at least 6 months before consideration for placement on the waiting list

• Metastatic (spreading) malignancy of the liver or other types of cancer

• Other serious diseases, such as uncontrolled infections, uncorrectable heart disease, or severe lung disease

• A history of missing your appointments and poor adherence to or noncompliance with prescribed medications

• Inadequate support from family or friends

• Human immunodeficiency virus (HIV)-positive status

• A history of multiple upper abdominal surgeries

• Advanced age

• Morbid obesity

Alcoholism is one of the most common causes of liver disease both in the United States and worldwide. Today, alcoholic liver disease is second only to hepatitis C as an indication for transplantation. Many years ago there were debates about whether patients with liver dysfunction due to alcoholic liver disease qualified for transplantation. Since then, our understanding of alcoholism has evolved; it is now viewed as a disease and, as such, patients suffering from alcoholism receive access equal to that of nonalcoholics in terms of transplants.

The vast majority (more than 90%) of the transplant programs in the United States require at least 6 months of total sobriety before transplantation may be considered. The reasoning behind this requirement is neither punishment nor an intentional delay in placement of patients with alcoholic liver disease on the waiting list. Rather, the liver, as a regenerative organ, can improve with abstinence to the point where liver transplantation may no longer be necessary. This process of functional regeneration continues for 1 year or more after stopping alcohol use but is most dramatic during the first 6 months of abstinence. If the patient continues to show signs of liver failure and portal hypertensive complications after 6 months of abstinence, the likelihood of recovery to normal liver function is low, and transplantation may be necessary. Most programs also require the patient to undergo rehabilitation and counseling during this 6-month time frame.

The success rates of liver transplantation for alcoholic liver disease are equal to the results for transplantation in cases of nonalcoholic disease. In fact, for those who remain abstinent from alcohol after transplantation, the long-term results may even be better because recurrent disease (such as hepatitis C) is not a concern.