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## Complete Summary

#### GUIDELINE TITLE

AASLD practice guidelines: evaluation of the patient for liver
transplantation.

#### BIBLIOGRAPHIC SOURCE(S)

Murray KF, Carithers RL Jr. AASLD practice guidelines: evaluation of the
patient for liver transplantation. Hepatology 2005 Jun;41(6):1407-32.
\[328 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15880505)

#### GUIDELINE STATUS

This is the current release of the guideline.

The guideline updates a previous version: Carithers RL Jr. Liver
transplantation. American Association for the Study of Liver Diseases.
Liver Transpl 2000 Jan;6(1):122-35.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Chronic liver failure from:

    -   Chronic noncholestatic liver disorders (e.g., hepatitis C,
        hepatitis B, autoimmune hepatitis, alcoholic cirrhosis)

    -   Cholestatic liver disorders (e.g., primary biliary cirrhosis;
        primary sclerosing cholangitis; childhood cholestatic disease,
        including biliary atresia, Alagille syndrome, and cystic
        fibrosis)

    -   Metabolic disorders (e.g., alpha-1-antitrypsin deficiency,
        Wilson disease, nonalcoholic steatohepatitis and cryptogenic
        cirrhosis, hereditary hemochromatosis, neonatal hemochromatosis,
        tyrosinemia and glycogen storage disease

    -   Metabolic disorders with severe extrahepatic manifestations
        (e.g., amyloidosis, hyperoxaluria, urea cycle defects, disorders
        of branched-chain amino acids)

-   Hepatic malignancies (e.g., hepatocellular carcinoma \[HCC\],
    hepatoblastoma, fibrolamellar hepatocellular carcinoma,
    hemangioendothelioma, cholangiocarcinoma)

-   Acute liver failure (fulminant hepatic failure \[FHF\]) of any cause

-   Other end-stage liver disease (e.g., Budd-Chiari syndrome,
    metastatic neuroendocrine tumors, and polycystic disease)

#### GUIDELINE CATEGORY

Evaluation\
Management\
Treatment

#### CLINICAL SPECIALTY

Critical Care\
Gastroenterology\
Infectious Diseases\
Internal Medicine\
Pediatrics\
Surgery

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To provide a data-supported approach to the treatment of patients
considered for liver transplantation

#### TARGET POPULATION

Individuals with acute or chronic liver failure

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Pre-Transplantation Evaluation and Management**

1.  Determination of need for referral to transplant center, based on
    signs and symptoms, and prognosis, determined through use of tools,
    including Child-Turcotte-Pugh (CTP) classification, the model for
    end-stage liver disease (MELD), and the pediatric end-stage liver
    disease (PELD) model

2.  Disease-specific alternative treatment

3.  Evaluation for coronary artery disease (dobutamine stress
    echocardiography, cardiac catheterization)

4.  Screening for pulmonary hypertension (Doppler echocardiography,
    right heart catheterization)

5.  Counseling to refrain from smoking

6.  Evaluation of renal function

7.  Consultation with oncologist, if applicable

8.  Screening for osteoporosis

9.  Formation of a well-coordinated, multidisciplinary team for human
    immunodeficiency virus (HIV) patients

10. Careful anatomical evaluation (patients with occlusion or hypoplasia
    splanchnic blood supply)

11. Counseling of patients with disorders that may adversely affect
    postoperative compliance

12. Pre-transplant colonoscopies, as indicated

13. Assessment for congenital heart disease in children with Alagille
    syndrome

14. Careful assessment of lung disease in children with cystic fibrosis
    and in all patients with cirrhosis secondary to alpha-1-antitrypsin
    deficiency

15. Screening for metabolic dysregulation in patients with decompensated
    cryptogenic cirrhosis

16. Screening for hemochromatosis in patients with newly diagnosed
    cirrhosis and pretransplantation phlebotimization, if indicated

17. Cardiac evaluation for all patients with hereditary hemochromatosis

**Liver Transplantation, including**

1.  Selection of patients for liver transplantation

2.  Timing of transplantation

3.  Retransplantation

**Pre- and Posttransplantation Treatment/Control of Comorbidities,
including**

1.  Medical therapy for pulmonary hypertension

2.  Efforts to improve bone density and prevent pathological fractures

3.  Antiviral therapy for hepatitis B and C (antiviral therapy)

4.  Immunosuppressive therapy

**Posttransplantation Care**

1.  Immunosuppressive therapy

2.  Metabolic monitoring

#### MAJOR OUTCOMES CONSIDERED

Outcome of transplantation versus the natural history of the disease in
question with respect to:

-   Survival rates

-   Morbidity and mortality

-   Graft survival

-   Quality of life

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

These recommendations provide a data-supported approach. They are based
on the following: (1) formal review and analysis of the recently
published world literature on the topic \[Medline search\]; (2) American
College of Physicians Manual for Assessing Health Practices and
Designing Practice Guidelines; (3) guideline policies, including the
American Association for the Study of Liver Diseases (AASLD) Policy on
the Development and Use of Practice Guidelines and the American
Gastroenterological Association (AGA) Policy Statement on Guidelines;
(4) the experience of the authors in the specified topic.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Grade I**: Randomized controlled trials

**Grade II-1**: Controlled trials without randomization

**Grade II-2**: Cohort or case-control analytic studies

**Grade II-3**: Multiple time series, dramatic uncontrolled experiments

**Grade III**: Opinions of respected authorities, descriptive
epidemiology

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

This guideline was produced in collaboration with the Practice
Guidelines Committee of the American Association for the Study of Liver
Diseases. This committee, in concert with a lead reviewer, provided
extensive peer review of this manuscript.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Evidence ratings (Grades I, II-1, II-2, II-3, and III) are defined at
the end of the \"Major Recommendations\" field.

**[When Should Evaluation for Transplantation Be
Considered?]{.underline}**

**Determining the Need for Liver Transplantation**

1.  Patients with cirrhosis should be referred for transplantation when
    they develop evidence of hepatic dysfunction (Child-Turcotte-Pugh
    \[CTP\] \>7 and model for end-stage liver disease \[MELD\] \>10) or
    when they experience their first major complication (ascites,
    variceal bleeding, or hepatic encephalopathy) (**II-3**).

2.  Children with chronic liver disease should be referred when they
    deviate from normal growth curves or develop evidence of hepatic
    dysfunction or portal hypertension (**II-3**).

3.  Patients with type I hepatorenal syndrome should have an expedited
    referral for liver transplantation (**II-3**).

**Exploring Alternative Forms of Treatment**

4.  Every option for disease-specific treatment should be considered in
    patients with chronic liver disease.

    a.  Only when there is no effective alternative therapy or when
        treatment has been shown to be ineffective should liver
        transplantation be considered (**II-3**).

    b.  However, in critically ill patients in whom the outcome of
        medical therapy is uncertain, it is appropriate to
        simultaneously begin specific treatment for the disease and to
        initiate evaluation for potential liver transplantation
        (**III**).

**Specific Medical, Surgical, and Psychosocial Issues**

5.  Chronic smokers, patients over the age of 50, and those with a
    clinical or family history of heart disease or diabetes should
    undergo evaluation for coronary artery disease (**III**).

6.  Dobutamine stress echocardiography appears to be an effective
    screening test in this setting; however, positive test results
    should be confirmed with cardiac catheterization (**II-2**).

**The Hepatopulmonary Syndrome (HPS)**

7.  Because patients with cirrhosis and severe hepatopulmonary syndrome
    have an extremely poor prognosis without transplantation, they
    should have an expedited referral and evaluation for liver
    transplantation (**II-2**).

**Portopulmonary Hypertension**

8.  All patients undergoing evaluation for potential liver
    transplantation should undergo screening for pulmonary hypertension
    (**II-3**).

9.  Doppler echocardiography is an excellent screening test in this
    setting; however, positive test results should be confirmed with
    right heart catheterization (**II-2**).

10. Patients with severe pulmonary hypertension should be considered for
    liver transplantation only if the condition can be effectively
    controlled with medical therapy (**II-3**).

**Obesity and Cigarette Smoking**

11. Morbid obesity should be considered a contraindication to liver
    transplantation (**II-3**).

12. All patients considered for liver transplantation should be
    encouraged to undergo efforts to abstain from smoking (**III**).

**Renal Failure**

13. The presence of renal insufficiency is an important predictor of
    postoperative renal failure and mortality after liver
    transplantation, and hence a thorough pretransplantation evaluation
    of renal function is important (**II-2**).

14. Because rapidly progressive hepatorenal syndrome (type 1) has an
    ominous prognosis and usually is reversed by transplantation,
    patients with this condition should have an expedited referral for
    evaluation (**II-3**).

15. Selected patients with chronic renal and liver disease should be
    considered for combined liver-kidney transplantation (**III**).

**Extrahepatic Malignancies**

16. Because the natural history and chance of recurrence varies with
    different tumors, close consultation between a patient\'s oncologist
    and transplantation physicians should occur before evaluation for
    liver transplantation in patients with extrahepatic malignancies
    (**III**).

**Osteoporosis**

17. All patients with chronic liver disease should be screened for
    osteoporosis during evaluation for liver transplantation (**II-3**).

18. In those with significant bone loss, efforts to improve bone density
    and to prevent pathological fractures should be pursued both before
    and after transplantation (**III**).

**Patients with Human Immunodeficiency Virus (HIV) Infection**

19. Liver transplantation in patients with HIV infection requires a
    well-coordinated, multidisciplinary team with expertise both in
    transplantation and HIV management (**III**).

**Surgical Issues**

20. Patients with occlusion or hypoplasia of the splanchnic blood supply
    require careful anatomical evaluation before transplantation because
    of the increased risk of perioperative mortality and graft loss
    (**II-3**).

**Psychosocial Issues**

21. Individuals should meet reasonable expectations of compliance before
    placement on a donor waiting list (**II-3**).

22. However, before a candidate is refused liver transplantation, every
    effort should be made to provide expert counseling and treatment of
    disorders that may adversely affect postoperative compliance
    (**III**).

23. Patients receiving methadone maintenance who are otherwise good
    candidates for transplantation should not be denied consideration
    for the operation (**II-2**).

**[Specific Indications for Liver Transplantation]{.underline}**

**Chronic Noncholestatic Liver Disorders**

*Chronic Hepatitis C*

24. Patients with clinically decompensated cirrhosis from chronic
    hepatitis C infection should be referred for consideration of liver
    transplantation (**II-3**).

25. Antiviral therapy should be considered in patients who have been
    accepted as candidates for liver transplantation, as long as
    treatment is administered by experienced clinicians, with vigilant
    monitoring for adverse events (**II-3**).

26. Treatment of hepatitis C virus (HCV)-related disease following liver
    transplantation should be undertaken with caution because of the
    increased risk of adverse events and should be performed under the
    supervision of a physician experienced in transplantation
    (**II-2**).

*Chronic Hepatitis B*

27. Patients with decompensated cirrhosis secondary to chronic hepatitis
    B should be considered for treatment with antiviral therapy in
    coordination with the transplant center (**II-3**).

28. Interferon-alfa should not be used in patients with decompensated
    cirrhosis because of the risk of exacerbation of liver disease
    (**II-3**).

29. The posttransplantation care of patients with hepatitis B virus
    (HBV) should include antiviral therapy (**II-3**).

*Autoimmune Hepatitis*

30. Liver transplantation should be considered in decompensated patients
    with autoimmune hepatitis who are unable to undergo or be salvaged
    by medical therapy (**II-3**).

31. Due to the risk of recurrent disease and enhanced risk of rejection,
    patients with autoimmune hepatitis may require more
    immunosuppression than patients transplanted for other indications
    (**II-3**).

*Alcoholic Cirrhosis*

32. To be considered for transplantation, potential candidates with
    alcoholic liver disease should have careful assessment by a health
    care professional experienced in the management of patients with
    addictive behavior (**III**).

33. It is prudent to delay transplantation for a minimum of 3 to 6
    months of abstinence from alcohol to avoid exposing patients who may
    not need transplantation to the risk of unnecessary surgery
    (**II-2**).

**Cholestatic Liver Disorders**

*Primary Biliary Cirrhosis*

34. Liver transplantation is the only effective treatment for liver
    failure secondary to primary biliary cirrhosis (**II-2**).

35. Liver transplantation also may occasionally be indicated in
    appropriately selected patients for uncontrolled pruritus (**III**).

*Primary Sclerosing Cholangitis*

36. Liver transplantation is the only effective treatment for
    decompensated cirrhosis secondary to primary sclerosing cholangitis
    (PSC) (**II-2**).

37. Patients with primary sclerosing cholangitis and cholangiocarcinoma
    should be excluded from transplantation unless they are enrolled in
    a clinical trial of experimental therapy (**II-3**).

38. Because of the high incidence of colon cancer, regularly scheduled
    colonoscopies should be performed both before and after
    transplantation in all patients who have inflammatory bowel disease
    (**II-3**).

*Childhood Cholestatic Diseases*

39. Liver transplantation is indicated in appropriately selected
    children with biliary atresia if portoenterostomy is unsuccessful,
    or if intractable portal hypertension or liver failure develops
    despite successful portoenterostomy (**III**).

40. Liver transplantation should be considered for its ability to
    significantly prolong survival and improve quality of life by
    reducing pruritus in syndromic and nonsyndromic forms of
    intrahepatic cholestasis in children (**III**).

41. Children with Alagille syndrome should have preoperative assessment
    for congenital heart disease, which is common in this condition
    (**III**).

42. In evaluating patients with cystic fibrosis for liver
    transplantation, careful assessment of lung disease should be
    performed (**III**).

**Metabolic Diseases**

*Alpha-1-Antitrypsin Disease*

43. Liver transplantation is the only effective treatment for
    decompensated cirrhosis secondary to alpha-1-antitrypsin deficiency
    (**II-3**).

44. Careful assessment for lung disease should be performed before
    transplantation in patients with cirrhosis secondary to
    alpha-1-antitrypsin deficiency, although coexistent disease is
    uncommon (**III**).

*Wilson Disease*

45. Urgent liver transplantation is the only effective option for
    patients with fulminant hepatic failure resulting from Wilson
    disease (**II-3**).

46. Liver transplantation also is indicated for patients with
    decompensated chronic disease who fail to respond to medical therapy
    (**II-2**).

47. Liver transplantation is not recommended as primary treatment for
    neurological Wilson disease because the liver disease is stabilized
    by medical therapy in most of these individuals, and outcomes with
    liver transplantation are not always beneficial (**III**).

*Nonalcoholic Steatohepatitis and Cryptogenic Cirrhosis*

48. Liver transplantation should be considered for selected patients
    with decompensated cirrhosis secondary to nonalcoholic
    steatohepatitis (NASH). The posttransplantation care of these
    patients should include metabolic monitoring (**III**).

49. Liver transplantation should be considered for selected patients
    with decompensated cryptogenic cirrhosis. These patients should be
    screened for metabolic dysregulation because of the possibility of
    underlying nonalcoholic steatohepatitis (**III**).

*Hereditary Hemochromatosis*

50. All patients with newly diagnosed cirrhosis should be screened for
    hemochromatosis using serologic tests, with genetic testing in
    equivocal cases (**III**).

51. Survival of transplanted patients with hereditary hemochromatosis is
    lower than in those transplanted for other causes of liver disease.
    Due to the increased risk of cardiac complications, a
    pretransplantation cardiac evaluation is essential (**II-3**).

52. Efforts should be made to phlebotomize these patients before
    transplantation (**III**).

*Neonatal Hemochromatosis*

53. Liver transplantation is the only effective treatment for infants
    with severe neonatal hemochromatosis. Urgent evaluation at a
    transplant center is recommended (**II-3**).

*Tyrosinemia and Glycogen Storage Disease*

54. Children with tyrosinemia who develop hepatocellular carcinoma (HCC)
    and meet the criteria for liver transplantation for HCC should be
    high-priority candidates (**II-3**).

55. Children with tyrosinemia and glycogen storage diseases unresponsive
    to medical management should be considered for transplantation
    (**II-3**).

56. Consideration of extrahepatic complications of the underlying
    disease must be carefully considered in potential transplant
    candidates (**III**).

**Metabolic Diseases with Severe Extrahepatic Manifestations**

*Amyloidosis and Hyperxaluria*

57. Patients with amyloidosis should be considered for liver
    transplantation to correct the underlying metabolic defect before
    end organ damage has occurred (**II-3**).

58. Liver transplantation, with or without combined kidney
    transplantation, is curative for hyperoxaluria and should be
    considered for patients with this disease (**II-3**).

*Urea Cycle and Branched-Chain Amino Acid Disorders*

59. Liver transplantation is indicated in children with metabolic
    diseases that cause progressive extra-hepatic injury resulting in
    significant morbidity and mortality that are not responsive to
    disease-specific medications or dietary modification and for which
    liver transplantation would result in the reversal of the enzyme
    deficiency and metabolic derangement (**II-3**).

60. Living related transplantation should be considered only if the
    enzyme activity of the donor would satisfactorily reverse the
    deficiency of the recipient (**III**).

61. The degree of neurological injury before transplantation should be
    considered when selecting patients for liver transplantation
    (**III**).

**Hepatic Malignancies**

*Hepatocellular Carcinoma (HCC)*

62. Liver transplantation should be viewed as the treatment of choice
    for selected patients with HCC who are not candidates for surgical
    resection and in whom malignancy is confined to the liver
    (**II-2**).

63. Optimal results following transplantation are achieved in patients
    with a single lesion 2 cm or larger and less than 5 cm, or no more
    than three lesions, the largest of which is less than 3 cm, and no
    radiographic evidence of extrahepatic disease (**II-2**).

64. For ideal outcomes, patients who meet these criteria should receive
    a donor organ within 6 months of listing for transplantation
    (**II-2**).

*Hepatoblastoma*

65. Liver transplantation should be considered for children in whom
    hepatoblastoma is confined to the liver and is not resectable
    (**II-3**).

*Fibrolamellar Hepatocellular Carcinoma and Hemangiondothelioma*

66. When the tumor is not resectable, liver transplantation should be
    considered for patients with fibrolamellar HCC, if there is no
    evidence of extrahepatic disease (**III**).

67. When the tumor is not resectable, liver transplantation should be
    considered for patients with epithelioid hemangioendothelioma
    (**III**).

*Cholangiocarcinoma*

68. Transplantation in patients with cholangiocarcinoma should be
    confined to a few centers with well-designed clinical trials
    (**III**).

**Fulminant Hepatic Failure**

69. Patients with fulminant hepatic failure (FHF) should be referred to
    a transplant center as quickly as possible for expectant critical
    care management (**III**).

70. Patients predicted to have little chance of spontaneous recovery
    should undergo transplantation as soon as possible (**II-3**).

**Miscellaneous Conditions**

*Budd-Chiari Syndrome*

71. Because there are a variety of effective options available, the
    selection of patients for liver transplantation for Budd-Chiari
    syndrome must be individualized, considering alternative therapeutic
    options (**III**).

*Metastatic Neuroendocrine Tumors*

72. Liver transplantation for metastatic neuroendocrine tumors should be
    confined to highly selected patients who are not candidates for
    surgical resection in whom symptoms have persisted despite optimal
    medical therapy (**III**).

*Polycystic Liver Disease*

73. Liver transplantation is occasionally indicated for patients with
    polycystic disease (**III**).

*Retransplantation*

74. Liver retransplantation, which is the only means of prolonging life
    in patients whose initial graft has failed, makes an important
    contribution to overall survival and should be considered in
    selected patients with primary graft failure, hepatic artery
    thrombosis, severe rejection, or recurrent disease (**II-3**).
    However, retransplantation is associated with diminished survival
    and increased costs compared with primary transplantation.

75. Retransplantation should be considered before patients develop
    severe hepatic and renal failure (**II-3**).

76. Retransplantation should be used with discretion in the emergency
    setting and should be avoided in subgroups of patients with little
    chance of success (**III**).

**[Definitions]{.underline}**:

**Quality of Evidence**

**Grade I**: Randomized controlled trials

**Grade II-1**: Controlled trials without randomization

**Grade II-2**: Cohort or case-control analytic studies

**Grade II-3**: Multiple time series, dramatic uncontrolled experiments

**Grade III**: Opinions of respected authorities, descriptive
epidemiology

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is specifically stated for each recommendation (see
the \"Major Recommendations\" field).

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Extended survival with excellent quality of life after
    transplantation in patients with end-stage liver disease

-   Liver transplantation has had a profound impact on the care of
    patients with end-stage liver disease and is the most effective
    treatment for many patients with acute or chronic liver failure
    resulting from a variety of causes.

#### POTENTIAL HARMS

-   Rejection, graft failure, and need for retransplantation

-   A number of complications can be anticipated after liver
    transplantation, including perioperative and surgical complications,
    immunologic and infectious disorders, and a variety of medical
    complications.

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

-   Severe pulmonary hypertension is associated with high perioperative
    mortality and, if not successfully treated, is a contraindication to
    liver transplantation.

-   Morbid obesity should be considered a contraindication to liver
    transplantation.

-   The most frequently encountered contraindication to transplantation
    is continued destructive behavior resulting from drug and alcohol
    addiction.

-   The most commonly encountered surgical contraindication to liver
    transplantation is absence of a viable splanchnic venous inflow
    system, either from portal vein thrombosis or cavernous
    transformation of the portal vein in children. Thrombosis of the
    main portal vein can be successfully bypassed; however, if the
    entire portal venous system is occluded or atrophied, attempts at
    transplantation are associated with a high risk of graft loss and
    perioperative mortality.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

Intended for use by physicians, the recommendations in this document
suggest preferred approaches to the diagnostic, therapeutic and
preventive aspects of care. They are intended to be flexible, in
contrast to standards of care, which are inflexible policies to be
followed in every case. Specific recommendations are based on relevant
published information. Specific recommendations are based on relevant
published information. In an attempt to characterize the quality of
evidence supporting recommendations, the Practice Guidelines Committee
of the American Association for the Study of Liver Diseases (AASLD)
requires a category to be assigned and reported with each recommendation
(See \"Rating Scheme for the Strength of the Evidence\" field). These
recommendations are fully endorsed by the AASLD.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Personal Digital Assistant (PDA) Downloads

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Murray KF, Carithers RL Jr. AASLD practice guidelines: evaluation of the
patient for liver transplantation. Hepatology 2005 Jun;41(6):1407-32.
\[328 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15880505)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2000 Jan (revised 2005 Jun)

#### GUIDELINE DEVELOPER(S)

American Association for the Study of Liver Diseases - Private Nonprofit
Research Organization

#### SOURCE(S) OF FUNDING

American Association for the Study of Liver Diseases

#### GUIDELINE COMMITTEE

Practice Guidelines Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Primary Authors*: Karen F. Murray; Robert L. Carithers, Jr.

*Committee Members*: K. Rajender Reddy, MD (Chair); Bruce R. Bacon, MD;
Henry C. Bodenheimer, MD; Robert L. Carithers, Jr., MD; Stanley M.
Cohen, MD; James E. Everhart, MD; Thomas W. Faust, MD; Steven L. Flamm,
MD; Gregory J. Gores, MD; Elizabeth Hespenheide, MSN, ACNP; Maureen M.
Jonas, MD; Michael R. Lucey, MD; Timothy M. McCashland, MD; David R.
Nelson, MD; F. Fred Poordad, MD; Margaret C. Shuhart, MD, MS; Brent A.
Tetri, MD; Zobair M. Younossi, MD,MPH; Nizar N. Zein, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Potential conflict of interest: Nothing to report

#### GUIDELINE STATUS

This is the current release of the guideline.

The guideline updates a previous version: Carithers RL Jr. Liver
transplantation. American Association for the Study of Liver Diseases.
Liver Transpl 2000 Jan;6(1):122-35.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in portable Document Format (PDF) from the
[American Association for the Study of Liver Diseases Web
site](http://www.aasld.org/practiceguidelines/Documents/Practice Guidelines/evalu_patient_livertransplantationpg.pdf).

Print copies: Available from the American Association for the Study of
Liver Diseases, 1729 King Street, Suite 200; Alexandria, VA 22314;
Phone: 703-299-9766; Web site: [www.aasld.org](http://www.aasld.org/);
e-mail: <aasld@aasld.org>.

#### AVAILABILITY OF COMPANION DOCUMENTS

This guideline is available as a Personal Digital Assistant (PDA)
download via the APPRISOR™ Document Viewer from
[www.apprisor.com](http://www.apprisor.com/).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on May 9, 2003. The information
was verified by the guideline developer on June 12, 2003. This NGC
summary was updated by ECRI on July 12, 2005.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the American Association for the Study of Liver Diseases\' copyright
restrictions.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/10/2008