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This document, on the indications and referral of patients for liver transplantation, was commissioned by the British Society of Gastroenterology (BSG) as part of a wider initiative to develop guidelines for clinicians in several areas of clinical practice.
The role of transplantation in end stage liver disease has reached a period of stability following a phase of rapid development over the past two decades. Emerging from an experimental high risk procedure to one where survival and rehabilitation is anticipated, it is appropriate to review the present evidence and synthesise this into a framework document for referring clinicians.
Guidelines are not rigid protocols and they should not be construed as interfering with local clinical judgement. Hence, they do not represent a directive of prescribed routes but a basis upon which clinicians can consider the option of transplantation more clearly.
2.0 Introduction and objectives
These guidelines tackle the inter-related topics of the indications and optimal referral practice for liver transplantation. Between 1980 and 1990, after several clinical advances, liver transplantation became established as the preferred treatment in a range of acute and chronic end stage liver disorders. Patient survival rates have improved steadily (⩾90% survival at one year is now achievable in low risk elective recipients) with an accompanying rapid expansion in liver transplant services. Hence, a considerable wealth of experience is now available for review and from which recommendations on indications for transplantation and patient selection can be derived.
Optimising referral practice to tertiary centres for transplantation is also tackled and the importance of the clinical status of the patient at the time of transplantation on the subsequent outcome of the procedure is reviewed. Delays in referral and extended waiting times for transplantation can allow unfavourable complications of advanced liver disease to supervene thereby jeopardising the outcome.
Guidelines are proposed on the two core questions: …
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