Rules for exclusion of liver transplant, adult-to-adult transplants....

[Linda-grosman]

  This is my second attempt to e-mail sorry if it is a duplicate. My sister is in liver failure, she has auto immune liver disease with hepatitis and cirrhosis. She was just diagnosed with sarcoma and she was told she could not be put on the liver transplant list because of the cancer. Why can liver cancer patients receive a liver? What are reasons for exclusion from the liver transplant list? Also, I heard about living donors for liver transplant in the University of Virginia Hospital. They took right lobe from donor and gave to receipient. Both regenerated. Have you heard about this? Is this an option for my sister (generally speaking)?
  Lastly, are there any artificial machines for "liver dialysis"? I heard about animal trials using a machine called SYBIOL (Harvard and Loyola Hospitals are using it). What about TriButyrate for liver failure? Thank you for responding.

[HFHSM.D.-D.M.]

Dear Linda Grossman:
Your questions are excellent ones and they are ones being asked more and more.  I appreciate the opportunity to address them.
The contraindications to liver transplant at Henry Ford include an active malignancy outside the liver, a serious on-going infection, poor heart or lung function, active substance abuse (drugs or alcohol) or a poor social support network for the patients.  
The reason that we sometimes are able to do a transplant in someone with liver disease is because the liver and hopefully the cancer are removed at the time of transplant and hopefully it will not come back.  However, we have to be careful to make sure that the liver cancer has not spread outside the liver before doing the transplant.  A cancer outside the liver would not be removed during the transplant and immuno-suppressive medications used after the transplant could make the cancer even worse.
Living donor transplants are done primarily for children.  Adults donate the left (smaller) lobe of the liver to a child for whom the small lobe is actually a good fit.  However, the Medical College of Virginia is doing living donation in adults where a healthy adult donates his/her right (larger) lobe to a recipient.  I am not certain your sister would be a candidate for this, however.  Usually the contraindications are the same.  Usually an individual has to be a candidate for a regular liver transplant before they are a candidate for a living donor transplant.
The artificial liver machines, I am afraid, are still in their infancy.  They are not nearly as effective as kidney dialysis and, at best, they may provide a very temporary window to allow regular liver transplant.  They cannot sustain patients for any extended period of time.  I am unaware of using TriButyrate though I would be happy to comment on any information or articles you could provide me.
Good luck with your  situation.  It sounds like a very difficult one though I am optimistic that there is something that can be done for your sister.   If I can be of any help, please do not hesitate to contact me either through MEDHELP or directly at Henry Ford at [phone].
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question physician when you have a question pertaining to your health.