The role of interventional radiology in the pre-liver transplant patient

Each year approximately 8500 patients undergo liver transplantation in the USA for acute and chronic liver failure. Over the years, the success of liver transplantation has led to more clinical indications for liver transplantation. These expanded indications, without a proportionate increase in don...

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Bibliographic Details
Published in:Abdominal imaging 2021, Vol.46 (1), p.124-133
Main Authors: Novelli, Paula M., Orons, Philip D.
Format: Article
Language:English
Subjects:
Cholestasis
Cirrhosis
Fitness
Gastroenterology
Hepatology
Hypertension
Imaging
Liver
Liver cancer
Liver cirrhosis
Liver diseases
Liver transplantation
Liver transplants
Medicine
Medicine & Public Health
Patients
Radiology
Signs and symptoms
Special Section: Liver Transplantation
Subgroups
Transplantation
Transplants & implants
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Summary:Each year approximately 8500 patients undergo liver transplantation in the USA for acute and chronic liver failure. Over the years, the success of liver transplantation has led to more clinical indications for liver transplantation. These expanded indications, without a proportionate increase in donors, result in increased competition for the limited pool of transplantable whole or partial grafts. The likelihood of receiving a deceased donor graft depends on many clinical variables, including the acute and chronic fitness of the candidate aligning with the timing of donor organ availability. Several types of patients are candidates for transplant: patients with acute fulminant hepatic failure who will die without a transplant, patients with decompensated cirrhosis, and patients with HCC and compensated cirrhosis. Interventional radiology can preserve equity between these subgroups and reduce patient dropout by increasing the physiologic and anatomic fitness of the candidate before and after formal listing. The primary determinants of candidacy fitness and dropout are the severity of clinical symptoms related to portal hypertension and the presence of hepatocellular cancer. There is a subgroup of patients whose disease severity is not accurately reflected by the Model for End-stage Liver Disease (MELD), such as patients with chronic cholestasis that also may benefit from IR management.
ISSN:2366-004X
2366-0058
DOI:10.1007/s00261-020-02704-2