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Miami Transplant Institute

Pediatric Liver Transplant Criteria

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Overview

There are three teams that provide the spectrum of care that patients receive at the MTI: pre-transplant, in-patient, and post- transplant. The team members include the transplant surgeons, transplant hepatologists or pediatric gastroenterologists, social worker, secretaries, patient financial services, dietician, psychiatrist, pharmacist and coordinators.

The MTI nurses play an important role in the transplant process. There are separate coordinators for pre-transplant, in-patient, and post- transplant. The pre transplant coordinator will assist you with completing your work up, being seen in clinic and getting on the transplant waitlist. While in-patient, a nurse coordinator will facilitate care, daily rounds with the physicians and discharge planning. The post-transplant coordinator will follow you in the out-patient clinic, review your labs with you and adjust your medications after discussing with the physician.

Indications for Transplant

A selection committee composed of transplant surgeons, hepatologists, nurse coordinators, psychiatrists,
social workers, dietitians and other interested individuals meets weekly to determine the suitability of
potential liver transplant candidates and determine the timing and priority for transplantation. General
indications for liver transplantation are as follows:

  • Irreversible cirrhosis with at least two signs of liver insufficiency
  • Fulminant hepatic failure: coma Grade 2
  • Unresectable hepatic malignancy confined to the liver that is less than 5 cm. in diameter
  • Metabolic liver disease that would benefit from liver replacement

Factors that are listed below are often the precipitating reason for proceeding with liver transplantation:

  • Severe fatigue
  • Unacceptable quality of life
  • Recurrent variceal bleeding
  • Intractable ascites
  • Recurrent or severe hepatic encephalopathy
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Development of small hepatocellular carcinoma on hepatic imaging

Indications:

  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Biliary Atresia/Alagille’s Syndrome
  • Autoimmune hepatitis
  • Fulminant and subfulminant hepatic failure
  • Alcohol related cirrhosis as cleared by Addiction team and or completion of rehabilitation with contract
  • Hepatitis B
  • Hepatitis C
  • Cryptogenic cirrhosis
  • NASH
  • Budd-Chiari
  • Hepatic trauma
  • Polycystic liver disease
  • HCC, unresectable
  • Sarcoidosis
  • Other: ________________________________________ (specify)

Inborn errors of metabolism:

Alpha 1 antitrypsin
Glycogen storage disease
Primary hyperoxalosis
Wilson’s disease
Urea cycle deficiencies
Tyrosinemia
Erythropoietic - Hemachromatosis
Protoporphyria
Familial homozygous hypercholesterolemia
Cystic fibrosis

  • High Risk Candidates
  • HIV positive
  • Age > 70 yr., or estimated biological age
  • ICU bound
  • Severe deconditioning, immobile, malnutrition
  • Obesity with BMI > 40 kg/m2
  • No social support
  • Extensive abdominal surgery or anatomical abnormalities hindering liver transplantation
  • Hematologic disease:
  • Paroxysmal nocturnal hemoglobinuria
  • Protein C and S deficiencies
  • Anti thrombin III deficiencies
  • Other hypercoagulable and myloproliferative states
  • Advance cardiac or pulmonary disease
  • Portal vein thrombosis, prior portosystemic shunts
  • Renal failure
  • Active variceal bleeding
  • Hepatic hydrothorax
  • Re-transplantation

Indications:

Primary non function

Hepatic Artery Thrombosis

Delayed Graft Dysfunction/Failure

Recurrent Disease *

Chronic Rejection

Ischemic Cholangiopathy or Secondary Biliary Cirrhosis

Other: ________________________________________ (specify)

*Recurrent HCV is a relative contra-indication

Contraindications:

  • Active systemic infections (sepsis, SBP, TB, other)
  • Neuropsychiatric illness
    Active substance abuse (alcohol, narcotics)
    Inability to comply with IS regimen
    Irreversible brain damage
    Active psychiatric disease that affects IS regimen compliance
  • Malignancy (except for localized HCC, skin cancers)
    Active extrahepatic malignancies. Must be documented and cleared by Hem/Onc.
    Rare exception: indolent malignancies cleared by oncology (ie epithelioid hemangioendothelioma
    metastatic neuroendocrine tumors)
    Hepatocellular carcinoma with gross vascular invasion.
    Cholangiocarcinoma with regional lymph node metastasis
    Hemangiosarcoma
  • AIDS
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