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9.10). Other organs also require attention. Bone disease post-transplantation is affected by the pre-transplantation bone status (especially in older patients, those receiving corticosteroids pre-transplantation and those with cholestatic liver disease) and post-transplant medications. Bone densitometry is required in such individuals for adequate evaluation and follow-up.

Pulmonary Function Tests

Co-existing medical conditions need to be ascertained. Uncontrolled infection outside the biliary tree is an absolute contraindication to transplantation. In the case of malignancy, metastatic hepatobiliary and extrahepatic malignancy are also absolute contraindications. For other neoplasias, a waiting period of 5 years after treatment of a solid organ tumor and 2 years for a hematological disorder is recommended. The presence of AIDS is a contraindication to transplantation, as post-transplant immunosuppression accelerates the course of the disease. Irreversible brain damage and multiorgan failure also preclude the liver transplant procedure.

iv) Psychosocial Assessment

It is important to predict the ability of the candidate to exhibit discipline and responsibility during his post-transplant care. Assessment of the patient's life style, psychological stability (including his/her perception of disability) and extent of family support require interaction with Psychiatry/Social Work support services. This evaluation is critical for patients with alcoholic liver disease, in whom the ability to abstain from alcohol post-transplant can be assessed by the ability to abstain before transplantation (at least 6 months), employment history and a support structure (family, friends). Patterns of drug abuse need to be explicitly discussed. Emergency psychiatric assessment is needed for acute hepatic failure from ingestion of acetaminophen with suicidal intent, as an interview should occur before the patient develops an altered mental state. If the latter is present, the team needs to rely on the individual history (e.g., previous suicidal attempts) and a family interview to reach a decision.

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