Indication and assessment for liver transplantation.

In chronic liver disease the most important aspect of patient selection is timing. Transplantation should improve both quality and quantity of life. The procedure is optimally carried out when the patient is well enough to withstand the procedure, but ill enough to warrant it (ie predicted survival is about 1–2 years without a transplant). Assessment for transplantation in chronic liver disease is difficult. Objective and subjective measures are used. The Child-Pugh classification2 (Table 1) allows objective assessment of a patient’s functional liver status and in the USA forms the basis for the criteria required to list patients. Those with Childs C grade have a 58%, 21% and 0% one-year, five-year and 10-year survival, respectively. Subjective measures of liver disease may be more difficult to assess. Tools are available to document quality of life3, and a full psychosocial assessment should be carried out.