iii) Assessment of Exclusion Criteria (Contraindications)

Older recipients are increasingly referred for evaluation. Although there is no absolute chronological limit for age above which transplantation is contraindi-cated, evaluation of physiological age requires a thorough clinical assessment. Adequate evaluation of cardiac function is critical. Obese and diabetic individuals are also at risk of atherosclerotic vascular disease and require full cardiovascular evaluation. While non-invasive cardiac testing may be adequate in the younger, otherwise healthy candidate, this will be insufficient for patients at risk (Table

Table 9.8. Testing to assess etiology of liver disease (blood tests)

Hepatitis B, HBV-DNA, HBeAg, anti-HBe, and anti-Delta Abs. Hepatitis C, HCV-RNA, HCV genotype

Autoimmune: Anti-smooth muscle Ab (ASMA), Antinuclear Ab (ANA),

Antimitochondrial Ab (AMA).

Alpha-1-antitrypsin level/phenotype.

Wilson: Ceruloplasmin, 24 hr urine copper, liver copper.

Hemochromatosis: Iron saturation, ferritin, HFE gene test.

Blood group (for listing purposes)

Table 9.9. Testing to assess the complications of liver disease

Arterial blood gases: r/o hypoxemia/hepatopulmonary syndrome Liver imaging: r/o hepatocellular carcinoma (HCC) Serum alpha-fetoprotein, Ca19-9: r/o HCC, cholangiocarcinoma Doppler ultrasound: r/o portal vein thrombosis (PVT) Upper gastrointestinal endoscopy: Assess portal hypertension Bone densitometry: Selected patients Neuropsychological testing: Selected patients

Table 9.10. Testing to exclude contraindications

Infectious disorders: HIV, syphilis, CMV, EBV, toxoplasmosis Malignancy: Colonoscopy in primary sclerosing cholangitis (ulcerative colitis)

ERCP in primary sclerosing cholangitis (cholangiocarcinoma) In HCC: bone scan, lung CT (metastatic workup) Screening (colon, breast, cervical, prostate cancer) Cardiopulmonary status: CXR, EKG, 2D-Echo (routine)

Thallium stress test, coronary angiography (patients at risk)

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