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Current Transplantation Reports

, Volume 5, Issue 3, pp 199–205 | Cite as

Transplantation for the Very Sick Patient—Donor and Recipient Factors

  • Arjuna Singanayagam
  • William Bernal
Liver Transplantation (D Mulligan, Section Editor)
First Online:
Part of the following topical collections:
  1. Topical Collection on Liver Transplantation

Abstract

Purpose of Review

Patients with end-stage chronic liver disease (CLD) frequently deteriorate with development of a ‘frail’ state and progress to development of extra-hepatic organ failures. Making the clinical judgement when a patient is ‘too sick’ to proceed with liver transplantation is challenging; we summarise recent studies that may inform decision-making.

Recent Findings

Reports quantify the impact of both recipient and donor factors related to early post-transplant survival, with consistent adverse association of advanced donor and recipient age, under-nutrition, sarcopenia and impaired functional status, and requirement for critical care unit admission and organ support. Survival for ‘very sick’ recipients has shown progressive improvement over time, but evidence is increasing of much greater post-transplant resource use and cost.

Summary

Factors associated with adverse outcomes in very sick recipients are becoming more clearly delineated. The increasing success of transplantation and exploration of its extended use must be tempered by the recognition of the consequences upon constrained clinical resources.

Keywords

Frailty Performance status Sarcopenia ACLF Outcome prediction 
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Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Kings College HospitalInstitute of Liver StudiesLondonUK

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