Table 2

Other aetiologies (non-liver failure) suitable for LT5 6 8 15

Variant syndromes*Hepatocellular carcinoma (HCC)†

  • Hepatopulmonary syndrome

  • Persistent and intractable pruritus

  • Polycystic liver disease

  • Familial hyperlipidaemia

  • Recurrent cholangitis

  • Familial amyloidosis

  • Hepatic epithelioid haemangioendothelioma

  • Nodular regenerative hyperplasia

  • Hereditary haemorrhagic Telangectasia

  • Ornithine transcarbamylase deficiency

  • Glycogen storage disease: symptomatic or presence

    of hepatic adenoma(s)

  • Primary hyperoxaluria: presence of renal impairment

  • Porphyria

  • Maple syrup urine disease

  • Portopulmonary hypertension

    Consider referral if raised mean pulmonary artery pressure (≥25 mm Hg), PVR >120 dynes/s/cm−5: PCWP <15 mm Hg with clinical response to medical therapy

  • Up to 25% of liver transplants in UK have HCC

  • Associated with most CLD (HBV, HCV, ALD, NAFLD, autoimmune liver disease, haemochromatosis) and Aflatoxin ingestion

  • Current LT selection criteria:

    • Single tumour <5 cm in diameter, or

    • Up to five tumours all ≤3 cm, or

    • Single tumour >5 cm and ≤7 cm in diameter if no progression over 6 months (larger HCC’s can be ‘downstaged’ by local therapies and then considered for transplantation)

    • AFP <1000

  • *A variant syndrome is a patient with chronic liver disease whose UKELD score is <49.

  • †All patients with HCC should be managed within a Liver cancer MDT, which would be expected to recommend referral for liver transplantation as one of the potential ‘outcomes’.

  • AFP, alpha foetoprotein; ALD, alcoholic liver disease; CLD, chronic liver disease; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, non alcoholic fatty liver disease; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance.