Refer Your Patient

To refer a patient for liver transplant evaluation or to speak with a member of our staff, please call 1-855-EMORYTX (366-7989) – toll free number, Monday through Friday from 8 a.m. to 4:30 p.m.

The following items are required for a liver transplant referral to be processed:

• Completed Referral Form (PDF 64 KB)
• Completed Referral Checklist (PDF 104 KB)
• Recent history and physical exam and/or office visit notes
• Liver biopsy slides (if available)
• Recent labs (within the last 3 months)
• Recent abdominal imaging/scans/EGD
• Copy of front and back of patient's insurance card

These items can be faxed to 404-712-2769. All patients referred for liver transplant evaluation will be reviewed by the liver transplant team.

Eligibility Criteria

• End-stage liver disease

• Absence of serious systemic illness or other medical conditions that may affect immediate or long-term survival

• Full understanding of transplant procedure, its limitations and long-term compliance to follow-up requirements

• Strong social support network

• Free from active drug, nicotine or alcohol abuse

Patients who do not meet the above criteria at the time of referral will be given the opportunity to fulfill these criteria and undergo re-evaluation. Formal input from the psychiatry staff is required to assess the risk of return to alcohol use following liver transplantation.

A useful method of assessing the severity of liver disease in most patients is the MELD (model of end-stage liver disease) score. This score is based upon three laboratory (blood work) values: INR, total bilirubin and the creatinine. The method of prioritization on the liver transplant waiting list is based upon the MELD score.

The MELD score accurately predicts your survival rate while waiting for a liver transplant as well as determining when a liver transplant should be considered.

Indications for Liver Transplant

• Presence of irreversible liver disease and a life expectancy of less than 12 months with no effective medical or surgical alternatives to transplantation.
• Chronic liver disease that has progressed to the point of significant interference with the patient's ability to work or with his/her quality of life.
• Progression of liver disease that will predictably result in mortality exceeding that of transplantation (85 percent one-year patient survival and 70 percent five-year survival).

Cholestatic Diseases: primary biliary cirrhosis, sclerosing cholangitis, secondary biliary cirrhosis, biliary atresia, cystic fibrosis.

Chronic Hepatitis: hepatitis B, hepatitis C, hepatitis D, autoimmune chronic active hepatitis, cryptogenic cirrhosis, chronic drug toxicity or toxin exposure.

Alcoholic Cirrhosis: Patients with alcoholic cirrhosis are considered for transplant if they meet current criteria for abstinence and rehabilitation.

Metabolic Diseases: hemochromatosis, Wilson's disease, Alpha-1-antitrypsin deficiency, glycogen storage disease, tyrosinemia, familial amyloidotic polyneuropathy, other metabolic disorders treatable by liver replacement.

Fulminant Acute Hepatic Necrosis: viral hepatitis, drug toxicity, toxin, Wilson's disease.

Primary Hepatic Tumors: selected patients with hepatocellular carcinoma.

Manifestations of end-stage liver disease include:

• Progressive jaundice
• Intractable ascites
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Encephalopathy
• Variceal bleeding
• Intractable pruritus
• Chronic fatigue
• Bleeding diathesis or coagulopathy

Clinical Indications for Liver Transplantation

Cholestatic liver disease:

• Serum Albumin < 3.0 g/d L
• Intractable pruritus
• Progressive bone disease
• Recurrent bacterial cholangitis

Hepatocellular liver disease:

• Serum Albumin < 3.0 g/d L
• Prothrombin time > 3 seconds above control

Both cholestatic and hepatocellular liver disease:

• Recurrent or severe hepatic encephalopathy
• Refractory ascites
• Spontaneous bacterial peritonitis
• Recurrent portal hypertensive bleeding
• Severe chronic fatigue and weakness
• Progressive malnutrition
• Development of hepatorenal syndrome
• Detection of small, coincidental hepatocellular carcinoma

Contraindications for Liver Transplant

Absolute Contraindications for Liver Transplant

• Continued use of alcohol or illegal drugs

• High risk of using drugs or alcohol again after surgery

• Failure to comply with doctor's instructions

• Inadequate support system

• Diagnosis of advanced liver cancer

• An extra-hepatic malignancy in the past three to five years

• Severe heart, lung or kidney disease

• Severe hardening of the arteries

• Systemic infections

Relative Contraindications for Liver Transplant

• Active systemic illness that would limit long-term survival

• Previous extra-hepatic malignancies

• Malnutrition

Emory Transplant Center