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may be elements of both theories in advanced of cirrhosis. On a practical level, the 3 biochemical tests used in the Child-Turcotte-Pugh classification have not been superseded by more sophisticated tests, such as those that arise from tests of drug metabolism (e.g., lidocaine, caffeine).

Recipient Evaluation

A thorough evaluation of the subject's candidacy for liver transplantation must include an assessment of the need, urgency and technical feasibility of OLT. The acuity and extent of the investigation is frequently determined by the severity of liver disease. In patients with fulminant hepatic failure, in whom therapeutic decisions need to be made over a short interval, the evaluation phase may need to be

Table 9.6. Liver abnormalities without cirrhosis

Congenital abnormalities Urea cycle enzyme deficiency Homozygous hypercholesterolemia Primary hyperoxaluria type I Familial amyloidotic polyneuropathy Developmental abnormalities Polycystic liver disease

Caroli's disease

Severe hyperammonemia may cause neurological deficits. Important to assess status of coronary arteries pre-OLT.

May also require renal transplantation.

Need to assess cardiac status. Disease may be too advanced.

OLT indicated for symptoms from massive hepatomegaly

Chronic biliary sepsis can be an indication for OLT.

Table 9.7. Prognosis in cirrhosis. Child-Turcotte-Pugh classification

Points

Reflecting Portal Hypertension

Ascites

Hepatic encephalopathy

Reflecting Hepatocellular Failure Bilirubin (mg%)

Prothrombin time (secs prolonged) Albumin (g%)

Minimum score: 5. Maximal score: 15 CTP Class: A: 5-6

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