Question: You are asked to see a 68 year old male with end stage liver disease for transplant evaluation. He has several comorbidities including diabetes mellitus type 2, chronic renal failure and a recently diagnosed multiple myeloma. Which of his risk factors is an absolute contra-indication for liver transplantation?
A. his age
C. renal failure
Answer: In this country as of 2011, there is no age limit to liver transplantation. That said, if somebody is 70 or above, they must otherwise be of robust health. In some countries, 65 is the limit for consideration.
Diabetes is not a contraindication to liver transplantation. In fact, many of the primary liver diseases we transplant are directly associated with insulin resistance, including fatty liver disease (NASH) and hepatitis C. The Hgb A1C should be well controlled, recognizing that metabolic syndrome is expected to occur post-transplant.
Since kidney transplantation sometimes occurs simultaneously with liver transplantation, renal failure is not contraindicated. Myeloma…is a problem. Nearly all extra-hepatic cancers are a contraindication for transplantation. For this reason, a thorough cancer-screening approach is vital to any transplantation workup. The man in this passage would be offered routine cirrhotic care.