Table 3-7Variant syndromes and definitions for selection to the adult elective liver transplant waiting list104


Diuretic resistant ascites

Ascites unresponsive to or intolerant of maximum diuretic dosage and non responsive to TIPS or where TIPS deemed impossible or contraindicated and in whom the UKELD score at registration is less than or equal to 49

Hepatopulmonary syndrome

Aerial Po2 less than 7.8 kPa. Alveolar-arterial oxygen gradient less than 20 mm Hg. Calculated shunt fraction greater than 8% (brain uptake following technetium macro-aggregate almumin), pulmonary vascular dilation documented by positive contrast enhanced trans-thoracic echo in the absence of overt chronic lung disease.

Chronic hepatic encephalopathy

Confirmed by EEG or trail making tests with at least two admissions in 1 year due to exacerbations of encephalopathy that has not been manageable by standard therapy. Structural or neurological disease must be excluded by appropriate imaging and if necessary paychometric testing.

Persistent and intractable pruritus

Pruritus consequent on cholestatic liver disease which is intractable after therapeutic trials which might include cholestyramine, ursodeoycholic acid, rifampicin, ondansetron, naltrexone and after exclusion of psychiatric co-morbidity that might contribute to the itch.

Familial amyloidosis

Confirmed transthyretin mutation in the absence of significant debilitating cardiac involvement or autonomic neuropathy.

Primary hyperlipidaemias

Homozygous familial hypercholesterolaemia with absent LDL receptor expression and LDL receptor gene mutation.

Polycystic liver disease

Intractable symptoms due to the mass of liver or pain unresponsive to cystectomy or severe complications secondary to portal hypertension.

From: 3, Alcohol-related liver disease

Cover of Alcohol Use Disorders
Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications [Internet].
NICE Clinical Guidelines, No. 100.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guidelines Centre.

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