Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

Guidelines on Evaluation for Liver Transplantation (LT) were published in 2005 by the American Association for the Study of Liver Diseases (AASLD). In the interim there have been major advances in the management of chronic liver disease, most notably in antiviral therapy for chronic viral hepatitis. Nonalcoholic fatty liver disease (NAFLD) has assumed increasing prominence as a cause of cirrhosis and hepatocellular carcinoma (HCC) requiring liver transplant. Furthermore, individual disease indications for LT such as HCC have been refined and specific guidelines have appeared for chronic viral hepatitis. Reflecting the need for a multidisciplinary approach to the evaluation of this complex group of patients who have the comorbidities typical of middle age, recommendations have been developed to assist in their cardiac management. With an increasing number of long-term survivors of LT there has been a greater focus on quality of life and attention to comorbid conditions impacting recipient longevity. The purpose of the current Guidelines is to provide an evidence-based set of recommendations for the evaluation of adult patients who are potentially candidates for LT. 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; (2) guideline policies covered by the AASLDPolicy on Development and Use of Practice Guidelines; and (3) the experience of the authors in the specified topic. Intended for use by physicians, these recommendations 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. To more fully characterize the available evidence supporting the recommendations, the AASLD Practice Guidelines Committee has adopted the classification used by the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) workgroup with minor modifications (Table 1). The classifications and recommendations are based on three categories: the source of evidence in levels I through III; the quality of evidence designated by high (A), moderate (B), or low quality (C); and the strength of recommendations classified as strong or weak.*