Management of pre‐liver transplantation patients—Part 1

Liver transplantation (LT) has emerged as the standard of care for patients with irreversible acute and chronic liver failure and various metabolic disorders (e.g., primary oxaluria, familial amyloidotic polyneuropathy).1 Due to the increasing incidence of end-stage liver disease and the limited number of grafts available for transplantation, the number of patient awaiting orthotopic LT has grown to 17,471 as of June 29, 2004.2 In 2003, 5,350 patients received an orthotopic LT. Most of the waitlisted candidates are followed in the community for their medical as well as hepatologic care.2 The limited number of transplants performed, along with long waiting periods, increase the chances of liver-associated complications and can make the management of these patients very challenging for the primary care provider. The aim of this article is to delineate the care of cirrhotic patients, with an emphasis on pre-LT workup and a focus on comprehensive medical care, complications related to portal hypertension, and surveillance, including screening for hepatocellular carcinoma (HCC).